NEURO PACKET 4 Flashcards
TX for dementia
Mild- moderate: _______
Moderate – severe _____ (Donepezil) + _____ (mematine) ((combo)
- Nonpharmological approaches may ↓ the rate of functional decline, ↓ demented pts caregiving needs, ↓ risk of dementia in normal individuals
o Aerobic ____ (45 minutes most days of the week)
o Frequent mental stimulation
Maintaining as active a role in the family and community as practically possible
Emphasizing activities at which the patient feels confident
Limited capacity to regain ___skills memory drills are more likely to lead to frustration than benefit & computerized cognitive training does not improve cognition or function - All forms of AD involve cholinergic degeneration of brain neurons, esp those that release ________
o Cholinergic neuron destruction causes cholinergic deficit
Opposite of Parkinson’s cholinergic excess
o AD pts contain senile ____ and neurofibrillary ____ concentrated In the same regions as cholinergic deficit
o Recent large study: AD2000 clinical trial in community dwelling patients with mild-mod AD found small and nonsignificant gains with treatment weigh out if it is worth it if the gain is small
o AA of Neurology, AA of Geriatric Psychiatry: use _______ inhibitors in appropriate patients – not clear who is appropriate (mild-mod, community living)
AD characterized by functional impairment of neurotransmitter systems, including the cholinergic system
Cholinergic decline linked to neuropsychiatric and functional deficits in AD
4 CIs approved for tx of mild-mod AD and Lewy Body Dementia
• Donepezil (_____) – oldest and most marketed
• Galantamine (Razadyne)
• Rivastigmine (______)
• Tacrine (big side effects: hepatotoxicity) (Cognex) not used much
Side effects include Nausea and diarrhea, uncommonly cardiac arrhythmias (do EKG prior to initiating therapy)
o Don’t respond to cholinesterase inhibitors Use antipsychotics - N-methyl-D-aspartate (NMDA) Antagonist = _______ (NAMENDA) targets the glutamatergic system, preventing cell death – can combine with Aricept (may have combo pills)
o Used for moderate to severe AD
o Shows clinical benefit and good tolerability
o Randomized, placebo-controlled study of 404 community living pts small study, still ongoing) with mod to severe AD looked at memantine (Namenda) with Aricept
Adding memantine for 24 weeks significantly better outcomes compared with placebo on:
• Cognition
• ADL (ex – can start brushing their teeth again)
• Behavior
• Clinical global status - Mood and behavioral disturbance SSRI
o Generally safe and well tolerated in elderly, cognitively impaired patients
o May be efficacious treatment of depression, anxiety or agitation
o Citolapram (_____) for agitation – or Lexapro
side effects may occur including QTc prolongation
o Paroxetine and TCAs should be avoided due to anticholinergic effects
o Buproprion (Wellbrutrin) or Venlafexine (Effexor) may also be tried - Insomnia TRAZADONE can be safe & effective
o OTC antihistamine hypnotics (Benadryl) must be avoided along with benzodiazepines due to worsening of cognition and tendency to precipitate delirium
o Other rx hypnotics such as zolpidem (Ambien) may result in similar adverse reactions
aricept
aricept and namenda
exercise lost acetylcholine plaques tangles cholenisterase aricept exelon memantine celexa
RADICULOPATHY
TREATMENT
• physical medicine : ____, use of ______(heat, cold, U/S, massage) to reduce pain
• If 2ndary to occupational hazard, train in use of ergonomics
exercise
modalities
SPINAL STENOSIS
- May need ____ consult
- Nonsurgical management: ______, non-narcotic meds, _____ injections, pain management
surgical
physical medicine
epidural
TREATMENT OF SPINAL TRUMA
• Immobilization and if there is cord compression, early decompressive ____ and _____ (within 24 hours)
• Early treatment with high dose corticosteroids (methylprednisolone 30mg/kg/h for 23 hours) may improve neurologic recovery if commenced within 8 hours after injury
• Anatomic realignment of the spinal cord by traction and other orthopedic procedures is important
• Subsequent care of residual neurologic deficit-paraplegia or quadriplegia-requires care of the skin bladder and bowels.
** do need to know a little bit about all this stuff but don’t need to know in detail … I think she means spinal cord syndromes?? Recommends having spinal tracts in front when reviewing to know sydromes
laminectomy
fusion
CEREBRAL PALSY
TREATMENT:
• Cerebral palsy can’t be ____ but treatment will often improve a child’s capabilities
• ___, ___
• ____ therapy
• Drugs to control ____, relax muscle spasms, and alleviate pain
• ____ to correct anatomical abnormalities or release tight muscles
• ____ and other orthotic devices
• Wheelchairs and rolling walkers
• Communication aids such as computers with attached voice synthesizers
cured PT, OT speech seizures surgery braces
MYASTHENIA GRAVIS
TREATMENT:
• Goal: maximize muscle ____, maintain functional ability
• Residual weakness is common
• With tmt, pts usually don’t die of this
• MG establishes within weeks to months; usually NOT progressive
• Course: spontaneous remission, remission with treatment, remissions with exacerbations
• _____ – first line if candidate for surgery
• _____
• Anticholinesterase medications – going to increase levels of acetylcholine minimally helpful
• Immunosuppression
• immunomodulation
• Plasmapheresis
• 80% of pts go into remission post-thymectomy
• Anticholinesterase drugs: were mainstay of tmt; now steroids
• Pyridostigmine (Mestinon); neostigmine (anticholinesterase)
• Taken 30 minutes before eating to increase strength for chewing and swallowing
• MESTINON:
o No longer the mainstay of treatment because of progressive lack of effect
o Inadvertent overdosage common
o Can provide symptomatic benefit
o 30 minutes before a meal to get thru eating
o Side effects: perspiration and diarrhea can be countered by adding atropine
• CURRENT TREATMENT:
o Increasing recognition of primary autoimmune disturbance
o _______ 50 mg/d: initial drug of choice for MG
o 1st dosing: a transient worsening of weakness may occur
o Rarely, respiratory failure
o PREDNISONE:
Continue for 2-6 months until normal strength regained
Thymectomy recommended for all pts with generalized MG, except very young and very old (**FR - When should patient’s be considered for a thymectomy in MG?)
Do it 3-6 weeks into prednisone therapy when pt is asymptomatic
• IMMUNOSUPPRESSIVE DRUGS: for this exam would just say immunosuppressive or immunomodulating
• Would use if still having symptoms after prednisone is discontinued
o Cyclosporin
o Mycophenolate
o Azathioprine
o Tacrolimus
o Methotrexate
o Rituximab (refractory MG)
o IVIG and plasmapheresis (work quickly; short duration of action)
• MG is a chronic disease that needs daily (sometimes hourly) skillful management
• Frequent rest periods
• Eat well-balanced, high potassium meals
• Avoid infections, undue stress
• Myasthenia Gravis Foundation: support group
strength
thymectomy
steroids
prednisone
MG CRISIS
TREATMENT:
• Eliminate offending ____
• Treat _____
• _____ support
• Lasts from days to weeks (avg: 2 weeks)
• Use of high dose steroids can precipitate a crisis; CAREFUL!
drugs
infection
vent
LAMBERT-EATON MYASTHENIC SYNDROME
TREATMENT: • Treatment of underlying \_\_\_\_ – if someone has lambert Eaton syndrome, we need to do a workup for cancer • IV \_\_\_ • \_\_\_\_\_ • Azathioprine – \_\_\_\_\_\_ • Plasmapheresis
cancer
IVIG
prednisolone
immunomodulator
AIDP - GUILLAN BARRE
TREATMENT:
• _________ (for 2 weeks or >)
• Intravenous administration of _______ (start in 1st week of sxs)
• Carefully monitor ______ status
• Mortality ~ 5%
• Most recover: 3-6 months
• 20% have permanent disabling weakness, imbalance or sensory loss
plasmaphoresis
gamma globulins
cardiopulmonary
