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Old DOOS > Neuro Lecture 4 > Flashcards

Neuro Lecture 4 Flashcards

1
Q

What medicines do you use controlled substance contract for?

A

any controlled substance

ex- benzos, opioids, sedatives, stimulants

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2
Q

what can you do to make sure people are following a controlled substance contract?

A

random drug screens (know metabolite list)

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3
Q

If they break a controlled substance contract what can you do?

A
  1. terminate services

2. offer rehab/ counseling

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4
Q

what is the primary reasons for a controlled medication agreement?

A

Patient education

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5
Q

What is a chronic inflammatory disorder of the CNS that is immune mediated?

A

Multiple sclerosis

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6
Q

MS is damage caused by the _____ immune system.

A

innate

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7
Q

Is MS auto-immune?

A

No, it is immune mediated

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8
Q

What is the pathology of MS

A

Inflammation disrupts BBB

T-cells and macrophages cause damage around the blood vessel involved

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9
Q

Is MS a white matter disease?

A

Not specifically, also affects grey matter

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10
Q

What imaging should you use for MS

A

Brain MRI with contrast

allows you to see inflammatory lesions

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11
Q

What will the lumbar puncture look like with a majority of MS patients?

A

oligocloncal bands of non-specific IgG

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12
Q

What is the most common cause of inflammation of the optic nerve (optic neuritis)

A

MS

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13
Q

is cognitive impairment typically a white or grey matter issue

A

grey matter

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14
Q

what are sign of MS

A

any neurologic sign

can be anywhere

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15
Q

how do diagnose MS?

A

History

MRI may not show smaller lesions

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16
Q

to be diagnosed with MS what must have happened

A

Basically, two or more attacks (demonstrated clinically or by MRI) disseminated in space and time

(ex- inability to use arm that got better then numbness in leg that then got better)

or one year of progressive symptoms and MRI show lesions disseminated by space

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17
Q

Diagnosis for patients who have had only one (monofocal) attack, or two or more (multifocal) attacks simultaneously.

A

Clinically isolated syndrome (CIS) means there is a high risk of developing MS

will treat them like they have MS

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18
Q

what are the 4 types of MS?

A

relapsing-remitting
progressive-relapsing
secondary - progressive
primary-progressive

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19
Q

What does the lesion normally follow in MS?

A

the artery. Usually perpendicular to the ventricles (because they follow a blood vessel

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20
Q

What does “benign MS” mean

A

Like relapsing remitting, but you return to baseline after every episode

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21
Q

What type of MS starts out as relapsing-remitting but converts into a progressive form

A

secondary progressive MS

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22
Q

what can help relieve acute symptoms of MS?

A

High-dose IV corticosteroids

Plasmapheresis may help some patients who don’t respond to steroid therapy

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23
Q

what are MS disease modifying treatments?

A

Interferon β-1a,
Interferon β-1b
Glatiramer acetate

reduces relapses by about 1/3
doesn’t work as well with people who get continuously worse

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24
Q

what are Natalizumab and mitoxantrone used for?

A

Second line agents for MS disease-modifying treatment.

Have severe side effects

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25
Q

Is there any effect pharmacologic treatment for progressive MS?

A

No

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26
Q

What can help MS patients after an episode to get them back to a functioning level?

A

Neurorehabilitation

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27
Q

When is MS commonly diagnosed and in whom?

A

20-50

more common in girl than women but equal once over 50

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28
Q

Is MS considered an inherited disorder?

A

No, but there are identifiable genes that make you more risk for developing it

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29
Q

Does MS affect life expectancy?

A

No, not significantly (only 5-10 years)

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30
Q

what is a prolonged, deep state of unconsciousness that lasts longer than 6 hours?

A

Coma

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31
Q

What causes a coma?

A

Dysfunction of the cortex or the reticular activating system

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32
Q

what are the three components of the Glasgow Coma Scale?

A

Eye
Verbal
Motor

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33
Q

how many points for eye

A

1-4

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34
Q

how many point for verbal?

A

1-5

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35
Q

How many points are for motor?

A

1-6

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36
Q

What’s the highest score for glasgow coma scale?

A

15

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37
Q

what is considered a severe brain injury on GCW?

A

3-8

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38
Q

What’s a normal range for GCS?

A

13-15

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39
Q

How do you record the GCS?

A

Total score then score for each and time

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40
Q

Causes of coma?

A

Intoxication
OD, Misdose
Stroke/ herniation of brain
head trauma, brain loss

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41
Q

what’s the most common cause of coma?

A

Drugs

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42
Q

Is hypothermia used to treat a coma or is it a cause?

A

Both

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43
Q

How do you diagnose coma?

A

Rule out locked-in state (can move eyes but nothing else)

Rule out psychogenic unresponsiveness (caloric stimulation)

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44
Q

What tests should you get one someone with a coma?

A

Toxin screen
glucose, BMP
brain imaging

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45
Q

What do all coma patients get put on for seizure prophylaxis?

A

levitoraceatam

46
Q

Posture where patient is flexed. Cortex is usually involved

A

Decorticate posturing

47
Q

Posture where patient is extended. Usually brainstem is cause of coma

A

Decerebrate (extensor) posturing

48
Q

If pupils are equal and reactive is the person probably in a coma?

A

No

49
Q

If a person have pinpoint pupils that are reactive what is the likely cause?

A

Opioid OD

50
Q

If both pupils are dilated and don’t react what is probably the case?

A

Not really alive

coudl really ahve hypothermia, severe hypoxia, stimulant OD, too much cocaine

51
Q

If one eye is dilated and unreactive with coma where is it probably

A

Ipsilateral side

52
Q

What is status epilepticus w/o physical signs

A

Subclinical status epilepticus

53
Q

What imaging tests should you do for coma?

A

MRI/ CT
EEG
battery of neuro tests

54
Q

why do you put coma patients in a hypothermic state.

A

saves brain tissue, less damage

55
Q

What can tetracycline and minocycline cause neurologically?

A

Pseudotumor cerebri (increased ICP)

56
Q

what can lidocaine cause?

A

Garrulousness (talking your ear off)
psychosis
used in cardio

57
Q

What is amiodarone used for and what is the common main problem of it.

A

anti arrythmic agent

tremor is the main problem

58
Q

what is a big problem calcium channel blocker cause?

A

tardive dykinesia (over time, usually around mouth)

59
Q

What can statins cause?

A

muscle pain and weakness

60
Q

What can dopamin-receptor blockers cause (enti-emetics)

A

Parkinsonian syndrome

61
Q

Lots of Tums or pills high in magnesium and aluminium what can they cause?

A

Imbalanced electrolytes

62
Q

what can salicylates (aspirin) cause?

A

seizures

63
Q

what can NSAIDs cause?

A

medication overuse headaches

64
Q

what is nicotine?

A

a powerful stimulant

65
Q

What do oral hormone replacements cause?

A

Stroke

66
Q

What does caffeine decrease?

A

blood flow in the brain

can cause enhanced physiologic tremor

67
Q

what is the most common reason for seeking medical care?

A

pain

68
Q

what are 4 types of pain

A

nociceptive pain (visceral, somatic)
neuropathic pain
psychogenic pain
idiopathic pain

69
Q

pain that is is often poorly localized but intense. Pain is found in ligaments, joints, blood vessels. Opiates are often used for this type pain

A

deep somatic pain

70
Q

pain is relatively well-defined and easy to locate

A

superficial

71
Q

what type pain indicates that the CNS and PNS and functioning correctly

A

nociceptive pain

72
Q

where does lung pain refer?

A

Shoulder

73
Q

Where does testicular pain refer?

A

Up towards kidneys

74
Q

pain due to the PNS malfunctioning due to injury or disease.

A

Neuropathic pain

75
Q

3 pain cuases of neuropathic pain

A

diabetic peripheral neuropathy
postherpetic neuraliga
cancer

76
Q

Press lightly on skin and it feels a lot harder (over sensitive to feelings in that area)

A

hyperalgesia

77
Q

Where connections aren’t made correctly. (ex- do a needle prick and they feel pain)

A

Allodynia

78
Q

pain that is more commonly caused by grief, social rejection, emotions often found in headache, abdominal pain, muscle aches, lower back.

A

psychogenic pain

79
Q

type of pain where no physical or psychosocial cause is identified

A

idiopathic pain

80
Q

what type pain is fibromyalgia?

A

idiopathic pain

81
Q

pain that extends beyond the period of healing as the result of an abnormality of the central nervous system (CNS not working correctly)

A

chronic pain

82
Q

is chronic pain nociceptive pain?

A

No, because CNS isn’t working correctly

83
Q

is the goal of therapy for chronic pain to get rid of the pain?

A

No goal is is to build a life that you can enjoy and be proud of.

84
Q

what type pain are opiate analgesics effective for?

A

Acute
Sharp
Moderate/severe
Visceral/deep-somatic pain

85
Q

what 2 conditions are there no indication for the benefit of long term opiate treatment?

A

chronic headache

osteoarthritis

86
Q

what is a NSAID drug that can be given for pain exacerbations

A

Ketorolac IM (give in the gluteus)
it will burn (acidic), give it slow
for an 8/10 or more

87
Q

when can’t you ketorolac?

A

When they are bleeding (ex- on period)

88
Q

what can you give when you suspect muscle spasm is the pain?

A

muscle relaxants

89
Q

what are some seadating tricyclic antidepressants?

A

amitriptyline, nortriptyline, (& trazodone- SARI)

90
Q

What are some SNRIs that are good with depression and daytime pain?

A

Duloxetine, venlafaxine, desvenlafaxine

91
Q

Name alpha adrenegeric agonists that are used so signal of pain doesn’t go into brain. Believed to stimulate inhibitory interneurons, useful for pain and muscle spasm.

A

Clonidine, tizanidine

92
Q

what drugs helps with the “gateway” theory? overload the pain stimuli

A

Capsaicin (don’t give with zoster)

menthol

93
Q

what are some other topical agents for pain?

A

Lidocaine

Ibuprofen, gabapentin

94
Q

what are some injected local anesthetics for pain

A

lidocaine

marcaine

95
Q

Stimulates nerves under skin

A

TENS (Transcutaneous electrical neurostimulation)

interferential current therapy (IFC)

96
Q

who normally develop an opiate addiction?

A

history of substance use disorder
psychiatric comorbidity
hx of pre-adolescent sexual abuse

97
Q

A physiological state characterized by a decrease in the effects of a drug (e.g., analgæsia, nausea or sedation) with chronic administration.
Need to increase dose for same effect

A

Tolerance (anyone on opiates will experience this)

98
Q

Physiological adaptation to the presence of a medication. The development of withdrawal symptoms when it is discontinued, when the dose is reduced abruptly or when an antagonist is administered.

A

Dependence

99
Q

Compulsive use of the medication for nonmedical reasons. Involves dysfnctional behaviors

A

Addiction

100
Q

Involves pain-relief seeking behavior. Iatrogenic condition, best treated by education

A

Pseudo-addiction

101
Q

who is pseudo-addiction the fault of?

A

The provider

102
Q

A chronic pain condition most often affecting one of the extremities (arm, leg, hands, or feet)

A

complex regional pain syndrome

103
Q

Type of CRPS that Usually occurs after an injury or trauma to that limb (usually has nerve damage)

A

CRPS-I

104
Q

Type of CRPS that can occur w/ no injury

A

CRPS-II

105
Q

who does CRPS not affect

A

children under 5, rarely under 10

106
Q

who does CRPS typically affect?

A 
Women, mean age is 52 
smoke tobacco (68% of patient do)
107
Q

what are some symptoms of CRPS?

A 
disproportionate to inciting event
may involve whole extremity 
edema (neurogenic) 
elevation in skin temp (good sign, easier to treat) 
abnormal sweating pattern
108
Q

what type osteoporosis is common w/ CRPS

A

patchy osteoporosis

109
Q

how do you diagnose CRPS?

A

history and physical exam
basically rule out a bunch of other things
EMG (show difference b/w type I and II)

110
Q

Some patients with CRPS have ___________ mediated pain that can be decreased by a nerve block.

A

sympathetic

111
Q

is amputation of a limb effective at controlling CRPS?

A

Not really, only helps 50%

Old DOOS (21 decks)

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