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Neuro Flashcards

1
Q

Addictive Personalities have decreased ____

A

Activity in the ventromedial prefrontal cortex

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2
Q

Hypothyroidism

A

Primary: destruction of the thyroid gland

Secondary: Hypothalamus or anterior pituitary gland

SS: tired, sleepy, low energy, mood alterations, difficult concentrating, decreased appetite, mimic depression or concussion.

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3
Q

Physiology of Thyroid Condition

A

Hypothalamus secretes TSH, TRH stimulates pituitary gland to release TSH, TSH acts on thyroid gland. Thyroid gland then releases t3 and t4. t4 is the inactive thyroid hormone. Calcitonin from parafollicular glands for bone building. t3 and t4 are from the follicular glands and influence metabolism

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4
Q

Treatment of hypothyroidism:

A

Levothroxine (Synthroid) - Synthetic form of T4

*hepatic metabolism CYP34A, highly PPB, excreted unchanged, drug interactions with antiseizure meds.

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5
Q

Sympathetic and Parasympathetic NS are

A

Outside of voluntary control

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6
Q

Ach exists as a NT in

A

Preganglionic PNS and SNS
Postganglionic in PNS
Somatic NS (binds to muscle receptors)
CNS

(peripheral and central NT)

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7
Q

Norepi exists as a NT in

A

(peripheral and central NT)
postganglionic in SNS
CNS NT
vital in adrenergic communication

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8
Q

COMT is the enzyme for

A

Catecholamines (epi and norepi)

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9
Q

MAO is the enzyme for

A

dopamine and serotonin

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10
Q

Cholinesterase is the enzyme for

A

Ach

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11
Q

NT’s that stimulate the SNS

A

catecholamines (epi and norepi)
Adrenergics
sympathomimetics

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12
Q

NTs the stimulate the PNS

A

cholinomimetics

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13
Q

Catecholamines stimulate the ____ nervous system

A

Sympathetic

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14
Q

Examples of catecholamines

A 
Epinephrine (a&b)
Norepinephrine (A&B)
Dobutamine (beta 1)
Dopamine (beta 1)
phenylephrine (alpha)
Ventolin (beta 2)
Serevent (beta 2)
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15
Q

Norepinephrine is more sensitive to ___ receptors

A

alpha

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16
Q

Cholinomimetics stimulate the ____ nervous system

A

Parasympathetic

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17
Q

Cholinomimetics in the PNS

A

stimulate acetylcholine
ex. mucomyst (increase secretions)
Pilocarpine (decrease intraocular pressure, in glaucoma)

SE (cholinergic effects)
hypotension, bradycardia, increased secretions, bladder spasms

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18
Q

Pilocarpine

A

Used for glaucoma to decrease intra ocular pressure.

  • eye drops
  • increases aqueous humour outflow.

SE: topical formulation, tearing, blurry vision, headache

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19
Q

Nicotine

A

affects cholinomimetic and adrenergic receptors.

Affects:
- Sexual arousal
-Decreased appetite, perception of pain, anxiety
-Increased glucose, 
-vasoconstriction/HR
-muscle contraction
BBB, highly addictive
*stimulates reward pathway.
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20
Q

Vaping

A

only research to be done was by food drug canada (for ingestion only)

  • aerosols inhaled are toxic.
  • Negative neuroplasticity.
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21
Q

Addiction

A

younger people start the more addicted they get, the brain learns to grow favouring addiction and addictive personality.

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22
Q

Addiction Treatment for Nicotine

A

Bupropion (zyban, wellbutrin)
- dopamine and norepi reuptake inhibitor.
SE: seizures, insomnia, headache , VS changes
*overstimulation of the brain

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23
Q

Indirect Adrenergic Agonists

A

Enhanced release of catecholamines

Meds:
Ephedrine (anti secretion med sudafed)
- enhanced focus, ability to perform, shakiness, nervousness.

Amphetamines: (Parkinsons drugs)
vasoconstriction, wakefullness, focus, elation, decreased appetite.

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24
Q

Clinical Amphetamines

A

treat ADHD: methylphenidate (ritaline, concerta)
SE weight loss, tachycardia, insomnia.

other uses: amphetamine, Methamp
- addictive street drug, performance enhancing.

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25
Crystal Meth
highly addictive, rave drug SE: dilated pupils, sweating, jerky movements, tachycardia, high BP, hyperthermia, hallucinations, panic attacks, aggressive behaviour, insomnia.
26
Alzheimer's Disease
Neurodegenerative disease: loss of neurons and synapses, Ach containing cells, plaque buildup. Risk factors include head injury, obesity, genetics, aging. No cure: treatment focusses on increasing amount of Ach in synapses.
27
Acetylcholinesterase Inhibitors (cholinesterase blockers)
stop cholinesterase enzyme from breaking down Ach. Meds: Galantamine/Rivistigmine (dementia tx) Neostigmine (no BBB, for mysthenia gravis)
28
Scopolamine
Anticholinergic (Ach block) - used for N&V Misuse can lead to dilated pupils, blurred vision, increased sensitivity to light, confusion, amnesia, sedation and unconsciousness.
29
Nicotinic Antagonists
Block Ach binding at nicotinic receptors (SNS, PNS, Skeletal muscle junctions) ``` Meds: Vecuronium Rocuronium Pancuronium Succinylcholine (short t1/2) *for short term paralyzation Botox ```
30
Curare
Nicotinic Antagonist (anticholinergic) Specificity to somatic NS -Causes respiratory muscle paralysis
31
Why does alcohol give us the munchies
Alcohol increases Ca influx into AgRp neuronal cells. This causes hunger signaling. These cells are only present in hypothalamus.
32
Norepinephrine
Excitatory when High: paranoia, anxiety, stress low: lethargy, low focus
33
Dopamine
Excitatory - reward pathway and pleasure High: anxiety, psychosis low: depression, lethargy
34
Serotonin
Inhibitory - calming mediator, balances mood High: lethargy low: anxiety, mood swings
35
GABA
Inhibitory - increases Cl influx, decreased cell activity high: lethargy, confusion, sedation, amnesia low: anxiety, insomnia
36
Glutamate
Excitory- NMDA receptor, memory, learning High: focus, anxiety low: low focus, poor retention
37
Substance P
Excitory: resp for pain
38
All CNS drugs have these cautions
cholinergic or sympathomimetic side effects - drug drug interactions - addiction - withdrawal - Dangerous with alcohol consumption
39
Seizure Treatment Goal
to increase GABA, decrease neuronal excitability.
40
Anxiety Treatment Goal
Increase GABA, increase serotonin
41
Psychosis Treatment Goal
Decrease dopamine and get a better balance
42
Seizure Meds
Benzodiazepines: -am Diazepam, Clonazepam -treatment of status epilepticus Barbituates -barbital Phenobarbital, pentobarbital Anticonvulsants (decrease neuronal activity, delay depolarization, increase GABA) Phenytoin, Carbamazepine, Valproic Acid
43
Assisted Suicide Meds
Secobarbital at high doses, metoclopramide for NV
44
Anxiety, Panic Attack Treatment
opens the Cl channel, more Cl in and calms the brain. Benzodiazepines 1st line and fast acting: Midazolam (versed), Lorazepam (ativan) Long acting -Diazepam (valium), Clonazepam (klonopin)
45
Euthanasia Drugs
Benzos, propofol and rocuronium
46
Benzodiazepine Abuse
Flunitrazepam (Rohypnol) 10x potency of valium -intermediate acting, peak 2 hours, duration 4-6 Alprazolam (Xanax) -used for recreational high.
47
Chronic Pain Treatment
Moderate efficacy opioids prescribed. Chronic pain changes the pain pathway, this often leads to complicated and difficult to treat pain. CBT is needed. Meds: Gabapentin (neurontin) -increases GABA (calming), excreted unchanged, addiction
48
Psychosis
Perceptive loss of reality SS: hallucinations, delusions, lack of awareness and judgement, mood and affect alterations ``` Etiology: mental health illness, schizophrenia, bipolar disorder, severe depression. Drug side effects Electrolyte imbalances Sepsis in elderly Overstimulation ```
49
Hallucinations
Deficit of the sensory information pathway. in sensory block stored images replace intel Neuronal dysfunction (hyperactivity, pathway dysfunction and end organ failure (drug induced, pathology - tumor)
50
Schizophrenia
Dysfunction of thoughts and language expression, chronic illness. SS: abnormal behaviours and movement incomprehensible speech invented words, disconnected words and thought processes, works Alterations in function, hallucinations, delusions, paranoia, disorganized thought. Mood alterations, agitated and unsettled. Withdrawn and apathetic. *this is a pathway dysfunction
51
Psychosis Tx
Neuroleptics: Selective D2 dopamine receptor block in limbic system. We want specificity to limbic system. high PPB, not addictive. Extrapyrimidal side effects like Tardive dyskinesia calls for stopping treatment. (basal ganglia are being stimulated)
52
Antipsychotic Drugs: D2 Antagonism
Chlorpromazine Haldol (these take 6-8 weeks to see an improvement) 5HT blockade, anticholinergic, sedation. *urinary retention, dry mouth, sexual dysfunction Neuroleptic Malignant Syndrome: hyperthermia, unstable BP, diaphoresis, incontinence. weaning protocols in place to prevent delirium tremens (shakiness, muscle spasm, disordered thoughts)
53
Withdrawal Symptoms
``` Irritbility insomnia anxiety tremors N&V Seizures hallucinations ```
54
Atypical Drugs for Psychosis
Olanzapine (zyprexa) (highly prescribed bc less sedation) Quetiapine (seroquel) Clozapine (clozaril) Risperidone (risperdal) These have minimal sedation, depot injections
55
Positive symptomology
restlessness, insomnia
56
Negative symptomology
depression, withdrawal, apathy, flat affect. | *sedation doesn't add to these
57
Adjunct Psychosis drugs
Lithium: Decreases Na cellular influx = stabilizes mood. decreased impulsivity and decreased mood swings. *serum monitoring, pregnancy category D
58
Depression Treatment Goals
increase serotonin, increase norepinephrine
59
Parkinson's Treatment Goals
Increase dopamine | -dopamine agonists
60
Dementia/Alzheimers Treatment Goals
increase Ach | -choliniomimetics
61
Parkinson's Disease
accumulation of lewy bodies and destruction of dopamine neurons. only at 75% destruction do we start to see symptoms. -inhibits impulse ability, muscles are rigid Meds: -Levodopa (synthetic dopamine), Rotigotine (Neupro)
62
Depression
SS: loss of interest in activities inability to experience pleasure, decreased concentrations, sleep alterations, appetite alterations, suicide ideation *common misdiagnosis is hypothyroidism *neurotransmitter dysfunction Drug induced, could have contributing illness
63
Depression Treatment
``` 1st line: SSRIs Fluvoextine (prosac) Sertraline (Zoloft) Paroxetine (paxil) Citalopram (celexa) ``` 2nd line: SNRIs Mirtazapine (remeron) Buproprion (wellbutrin)
64
Serotonin Syndrome
Agitation, hallucinations, tachycardia, BP changes, NV, diarrhea A sudden surge of serotonin
65
Conscious Sedation
``` Drugs: Ketamine (crosses BBB) decreases CNS excitation -decreased glutamate Ca Channel blockade Central analgesia Doesn't affect GABA ``` Sensory blockade, amnesia, altered resps and VS.
66
Anesthesia Goals
1. unconsciousness 2. Pain control 3. Loss of reflexes (procedure dependant)
67
General Anesthetic
unconsciousness: Propofol IV, to keep unconscious. Nitrous Oxide (used for induction of unconsciousness) Analgesia: Fentanyl (causes less itching than morphine Muscle paralytics for loss of reflexes - Rocuronium
68
Propofol
Sedative hypnotic and GA onset - 10-15 seconds increases GABA SE: no analgesia, resp depression, hypotension
69
Rocuronium
Muscle relaxant and paralytic. | onset 1-3 minutes, duration 15-60 mins
70
Local Anesthesia
``` Sodium Channel blockers (no cellular depolarization) Meds: -pilocaine (longer duration) -lidocaine -buprivicaine (longer duration) ```
71
Cocaine
BBB damage, alters the permeability of the BBB
72
Nerve blocks
local anesthetic injected near the nerve or inferior to the root.
73
Adjunct to local anesthetics
Epinephrine -increased vasoconstriction, localized effect Opioids: pain relief.
74
Epidural Anesthetic
cervical, thoracic, lumbar | Location ensured by no CSF return in needle.
75
Ropivacaine
Selective drug for sensory fibers, not for motor. Used in labour and delivery
76
Side effects of epidural
loss of sensation, hypotension, resp depression, catheter migration, site infection, hematoma. Urinary retention, injury and CSF infiltration
77
Spinal Intrathecal Anesthetic
Drug delivered directly into CSF Blocks a band of nerves always delivered below L2, avoids cord damage

NURS216A (15 decks)

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