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Pathophysiology and Pharmacology 2 > Neuro: Disorders of Motor Function > Flashcards

Neuro: Disorders of Motor Function Flashcards

1
Q

Parkinson’s Disease About + Etiology

A

Idiopathic, chronic, progressive degenerative disorder of CNS
motor, neuropsychiatric manifestations
50+ in age
2nd most common neurodegenerative disorder

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2
Q

Parkinson’s s/s

A 
tremors
bradykinesia (chew, swallow, speak)
muscle rigidity
postural instability
flat affect
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3
Q

Conditions Causing Secondary Parkinsonism

A 
head trauma
toxins
metabolic disorders
infections
multiple strokes in basal ganglia
atypical antipsychotics&antiemetics
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4
Q

Parkinson’s Causes

A

90% Idiopathic

10% Genetic

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5
Q

Increased RF for Parkinson’s

A 
increased age (most significant)
male
exposure to pesticides, metals
family history of PD
genetic mutations
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6
Q

Decreased RF for Parkinson’s

A

cigarette smoking
caffeine intake
high blood urate levels

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7
Q

Parkinson’s Pathogenic Mechanisms

A 
proteolytic stress (too many proteins, Lewy bodies)
oxidative stress (too little gluutathione, increase in iron, reactiev oxygen species)
mitochnodrial dysfunction (decreased mitochondrial activity by 30-40%)
inflammation (overactive microglia, excess production of neurotoxic factors)
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8
Q

Parkinson’s Manifestations

A

insidious onset
Motor: tremor in resting hands/lips/chin/legs/mouth, regidity from increased muscle stiffness/tone, cogwheeling, bradykinesia, postural instability
Nonmotor: fatigue/sleep disturbances, olfactory dysfunction, pain, autonomic dysfunction
Neuropsychiatric: cognitive dysfunction, dementia, psychosis, hallucinations, mood disorders, depression, anxiety

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9
Q

Parkinson Disease Stages

A 
Stage 1 (mild s/s on one side only, changes in posture/locomotion/facial expression)
Stage 2 (bilateral symptoms/minimal disability, posture&gait effected)
Stage 3 (significant slowing of body movements, early impairment of equilibrium on walking/standing, generalized dysfunction moderately severe)
Stage 4 (severe symptoms, rigidity & bradykinesia, can still walk to a limited extent, unable to live alone, tremor may be less than in earlier stages)
Stage 5 (cachectic stage, invalidism, cannot stand or walk, requires constant care)
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10
Q

Parkinson’s TX

A 
pharmacologic replenishment w/ dopaminergic drugs 
dopamine agonists
anticholinergic agents
amantadine
monoamine oxidase inhibitors
catecol-o-methyltransferase inhibitors
ablation surgery
deep brain stimulation 
complementary & supportive therapies
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11
Q

Dopamine Agonists (ex/Moa/Se/Monitoring/Teaching/Preg)

A

levodopa/carbidopa
increases biosynthesis of dopamine in nerve terminals
uncontrolled/purposeless movements, involuntary movements, loss of appetite, n/v
monitor LFTs, contraindicated in narrow-angle glaucoma
discontinue gradually
C

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12
Q

Anticholinergic Agents (Moa/ex/Use/Se/monitoring/teaching/Preg)

A

block acetylcholine to inhibit overactivity
benztropine
tx early stages of Parkinson’s
dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma
watch liver disease, severe constipation, blockage of urinary tract
monitor for hypotension/tachycardia
avoid alcohol
C

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13
Q

Multiple Sclerosis

A 
chronic inflammatory demyelinating degenerative disorder of CNS
inflammatory autoimmune diease
lesions throughout CNS
progressive disease
unknown/no cure
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14
Q

MS RF

A 
age
gender
ethnicity
geography r/t latitude
genetics
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15
Q

MS Pathogenesis

A

development of plaques
demyelination which causes conduction blocks and axonal degeneration
atrophy of gray matter (r/t cognition)

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16
Q

MS Development

A

initial: clinically isolated syndrome
Relapsing-remitting multiple sclerosis (RRMS) [stable for 10-20 years]
Secondary Progressive MS (SPMS) [gradual worsening may have occasional relapses, minor remissions, plateaus]
Primary Progressive MS (PPMS) [progressive deficits w/ occasional plateaus, temp improvements or acute relapses]

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17
Q

MS s/s

A 
sensory symptoms in extremities/face
visual loss
double vision
slurred speech
weakness
vertigo
gait/balance disturbances
bowl&bladder problems
neuropathic pain
spasticity
bilateral internuclear opthalmoplegia
fatigue
cognitive dysfunction
heat sensitivity 
sexual dysfunction
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18
Q

MS DX

A

CNS lesion disseminated in time & space
MRI (McDonald criteria/plaques present)
Blood tests to rule out other disorders
evoked potentials recording timing of CNS response to stimuli
EEG
lumbar puncture

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19
Q

MS TX

A 
immunomodulatory therapy
amantadine/modafinil for fatigue
spasticity
physical therapy
routine stretching program
medications
intramuscular botulinum toxin
nerve blocks
intrathecal baclofen pump placement
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20
Q

Immune-modulating Drugs (Moa/use/SE/monitoring/teaching/preg)

A

uknonwn, interferes with cell-binding
reduces severity of MS symptoms, decreases lesions
flushing, chest pain, weakness, infection, pain, nausea, joint pain, anxiety, muscle stiffness
liver fx, depression, suicidal ideation
rotation of injection sites/use new needles
C

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21
Q

Amyotrophic Lateral Sclerosis

A

Lou Gehrig’s Disease
progressive neurodegenerative disease
causes weakness/disability/death w/in 3-5 years

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22
Q

Amyotrophic Lateral Sclerosis RF/Etiology

A

age/family history
no direct mechanism known
similar to prion disease/malignancy
motor axons die by wallerian degneration

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23
Q

Amyotrophic Lateral Sclerosis Pathways

A 
oxidative stress
mitochonodrial dysfunction 
defect of axonal transport
abnormal growth factor expression 
excitotoxicity
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24
Q

Amyotrophic Lateral Sclerosis s/s

A 
insidious onset
slowly progressive, painless weakness in one or more body parts
upper motor neuron s/s
lower motor neuron s/s
bulbar dysfunction (CN 9/10/11/12)
frontotemporal executive dysfunction
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25
Amyotrophic Lateral Sclerosis DX
``` based primarily on s/s electromyography nerve conduction studies MRI/CT of brain & spinal cord muscle or nerve biopsy genetic blood tests world federation of neurology diagnostic algorithm ```
26
Amyotrophic Lateral Sclerosis survival rate/TX
3 years riluzole noninvasive ventilation percutaneous endoscopic gastrostomy tube feeding meds to relieve symptoms/maximinze remaining function multidisciplinary approach to care
27
Amyotrophic Lateral Sclerosis Stages
1 (symptom onset involvement of first body region) 2A (diagnosis 35% thru) 2B (Involvement of second body region 38% thru) 3 (involvement of thirst body region 61% thru) 4A (Need for gastrostomy/feeding tube 77% thru) 4B (Need for noninvasive ventilation 80% thru)
28
Huntington Disease
progressive, incurable neurodegenerative disease of brain causes uncontrolled involuntary movements, dementia, behavior changes onset ages 35-44 primary causes of death (19 years after diagnosis) pneumonia&cardiovascular disease
29
Huntington Disease Etiology/Pathogenesis
autosomal dominant inheritanges (HTT) chromosome 4 leads to neuronal cel death excitotoxicity oxidative stress impaired metabolism opoptosis
30
Huntington Disease Pathology
gross atrophy in caudate nucleus & putamen w/ selective neuronal loss & gliosis neuronal loss in cerebral cortex varying degrees of atrophy in other areas in midbrain & cerebellum shrinkage of brain in olum numerous biochemical defects
31
Huntington Disease Severity
Grade 0: no detectable histologic neuropathology/no gross striatal atrophy Grade 1: neuropathologic changes detected microscopically by w/out gross atrophy Grade 2: striatal atrophy present, caudate nucleus remains convex Grade 3: striatal atrophy more severe, caudate nucleus flat Grade 4: striatal atrophy most severe, medial surface of caudate nucleus concave
32
Huntington's Manifestations
``` involuntary movements chorea parkinsonian features akinetic-rigid syndrome dysarthria dysphagia abnormal eye movements tics myoclonus short-erm memory loss impaired intellectual function dementia psychiatric manifestations irritability moodiness depression OCD untidiness antisocial apathy ```
33
Huntington Disease DX
genetically proven family history clinical presentation MRI/CT to measure brain atrophy referral to neurologist who specializes in HD
34
Huntington Disease TX
reduce symptoms & improve quality of life tetrabenazine for chorea antidepressant or antipsychotic medications levodopa/dopamine agonist
35
Seizure Activity Definition
abnormal/uncontrolled electrical discharges within brain
36
epilepsy
seizures occurring chronically
37
Seizure Diagnosis
``` lab tests (cbc, bmp, cmp, urine culture, lumbar puncture) EEG Lead level, toxicology screening CT san MRI w/ angiography ```
38
Seizures Infant Causes
congenital anomoloies perinatal brain injury metabolic imbalances
39
Seizures Late Childhood
CNS infections neuro degenerative disorders inherited epilepsies
40
Seizures Adult Causes
trauma cerebrovascular disorders neoplastic disease
41
Seizure s/s
loss of conscious awareness of environment varying patterns of muscular rigidity/relaxation aura
42
Status epilepticus
life-threatening | enhanced/sustained electrical activity over 30 minutes or more
43
Febrile Seizures
acute illness, rapid temperature rise above 102.2 tonic-clonic activity (1-2 min) rapid return to conciousness
44
Partial Seizures (Focal Seizures)
contained w/in limited area of brain simple: hallucinations/intense emotions/twitching complex: typically w/ aura, postictal confsion
45
Intractable Seizures
refractory (can happen even w/ optimal medical management) | require referral to epilepsy center
46
Absence (petit mal)
seizures last few seconds most often in children | s/s: stare into space, no response to verbal, fluttering eyelids, jerking
47
Tonic-clonic (grand mal)
aura, tonic (intense muscle contractions) alternate with clonic (relaxation muscles) postictal state (disoriented & deep sleep)
48
Tonic Phase
``` 15-60 seconds muscle rigidity sudden loss of consciousness pupils fixed/dilated increased metabolic demans hypoxia urinary/bowel incontinence ```
49
Clonic Phase
60-90 seconds alternating muscle contraction/relaxation in extremities hyperventilation eyes roll back/forth at mouth
50
Postictal Period
decreased level of consciousness/sleepy quiet/relaxed breathing gradual regaining of consciousness
51
Seizure Meds & Contraceptives
decrease efficacy of oral contraceptives
52
Eclampsia
severe HTN disorder of pregnancy | characterized y seizures/coma/perinatal mortality
53
Seizure Medications
``` initial low dosing gradually increased newer meds have fewer side effects may double risk of suicidal behavior GABA-potentiating drugs ```
54
Barbituarates
controll seizures SE: dependence drowsiness, vitamin deficiencies, laryngospasm monitor liver/kidney function report pregnancy immediately at risk for bleeding, drowsiness, bone pain Preg Cat D
55
Phenobarbital (class/use/admin/SE/Contra/interx)
Long acting Barbiturate used for management of seizures IM may cause local inflammatory response IV (rarely used) can cause tissue necrosis controlled substance (can cause dependence) drowsiness vitamin deficiencies OVERDOSE: respiratory depression, CNS depression, coma, death Severe uncontrolled pain, pre-existing cNS depression, glaucoma, prostatic hypertropy don't mix w/ alcohol/CNS depressants may increase metabolism of other medications reducing effectiveness
56
Benzodiazepines (use/se/monitoring/teaching/overdose/preg)
``` short-term seizure control similar to barbiturates but safer drowsiness/dizziness drug-abuse potential contra for narrow-angle glaucoma respiratory depression w/ other CNS depressants rebound seizures if discontinued abruptly D ```
57
Flumazenil
antidote to benzodiazepines | not usually given if taking benzos for a reason chronically
58
Diazepam (class/admin/se/contra/interx)
anti-seizure drug benzo oral better, if IV (assess RR Q5-15 min, have airway equipment ready) IV: hypotension, muscular weakness, tachycardia, resp depression INJ: avoid in shock/coma/depressed vital signs/newborns PO: avoid in infants/narrow-angle glaucoma/within 14 days of monoamine oxidase inhibitor therapy don't combine w/ alcohol levodopa/barbiturates decrease efficacy if taken with phenytonin increases toxicity
59
Hydantoin Meds (use/se/monitoring/teaching/preg)
``` desensitize sodium channels tx epilepsy except absence seizures CNS depression, gingival hyperplasia (excessive gum growth) skin rash dysrhthmias hypotension fatal hepatoxicity serum drug levels, signs of toxicity, blood dyscrasias, bleeding disorders, liver/kidney fx need routine labs report hypoglycemia/pregnancy D ```
60
Phenytoin (class/use/se/bbw/contra/inx)
``` hydantoin antiseizure can cause dysrhythmias bradycardia ventricular fibrillation severe hypotension hyperglycemia headache nystagmus ataxia confusion slurred speech nervousness twitching insomnia peripheral neuropathy (long-term) agranulocytosis rashes exfoliative dermatitis SJS connective tissue reactions watch cardiac monitoring during/after IV rash/sinus/bradycardia/heart block w/ tricyclic antidepressants = seizure ```
61
Valproates (class/use/admin/se/bbw/contra/interx)
``` phenytoin-like drug antiseizure don't crush/chew ER sedation/drowsiness GI upset prolonged bleeding time visual disturbances muscle weakness tremor psychomotor agitation BMS weight gain abdominal cramps rash alopecia pruritus photosensitivity erythema multiforme fatal hepatoxicity pancreatitis/tertogenic effects liver disease/bleeding dysfunction/pancreatitis/congenital metabolic disorders don't give w/ warfarin (bleeding) or alcohol increases w/ phenobarbital ```
62
Succinimides (use/se/monitoring/teaching/preg)
``` tx absence seizures impaired mental/physical abilities psychosis/extreme mood swings dizziness HA lethargy fatigue ataxia sleep disturbances caution admin w/ phenothiazines/anti-seizure meds/antidepressants don't abruptly withraw watch mental status C ```

Pathophysiology and Pharmacology 2 (27 decks)

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