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Palliative Care > Neuro pal care > Flashcards

Neuro pal care Flashcards

1
Q

Sx after stroke: Depression and emotional lability

A

Incidence: 30%
Assessment tool: PHQ2 or 9, (HAM-D)
Management: SSRI
- emotional lability: dextromethorphan/quinidine

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2
Q

Sx after stroke: Anxiety

A

Incidence: 20%
Assessment tool: HAM-A, GAI, HADS
Management: SSRI

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3
Q

Sx after stroke: Delirium

A

Incidence: 10-48%
Assessment tool: CAM-ICU, DRS, 3D-CAM, 4AT
Management: behavior mod, antipsychotics for severe

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4
Q

Sx after stroke: Dysphagia

A

Incidence: 20-50%
Assessment tool: Swallowing eval, FEES
Management: Rehab, special diet. (NG tube or PEG can improve nutrition but not stop aspiration)

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5
Q

sx after stroke: Pain

A

Incidence:
- central poststroke pain 12%
- hemiplegic shoulder pain 48-84%
Assessment tool: Abbey pain scale, vertical VAS, FPS
Management:
- CPSP: amitriptyline, lamotrigine
- HSP: electrical stimulation, PT, NSAIDS. massage, ice/heat, botox

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6
Q

Sx after stroke: Poststroke spasticity (PSS)

A

Incidence: 30%
Assessment tool: Modified Ashworth Scale, Tardieu scale, Carer Burden Scale
Management: Botox injection, PT, splint, antispasmotic agents

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7
Q

Sx after stroke: Fatigue

A

Incidence: 50%
Assessment tool: FSMC, Fatigue severity scale
Management: Modafinil, amantidine, methylphenidate

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8
Q

Sx after stroke: Urinary incontinence

A

Incidence: 50% initial
- 20% at 6mo
Assessment tool: urodynamic testing, postvoid residual, bladder stress test
Management:
-nonpharm: wt loss, diet changes, pelvic floor exercises.
- Pharm: alpha blockers, antimuscarinic drugs, SNRIs
- Surgical if unresponsive

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9
Q

Sx after stroke: Fecal incontinence

A

Incidence: 10% at 6 mo
Assessment tool: anorectal manometry, endorectal ultrasound/MRI, defecography
Management: Supportive care, bulking agents, antidiarrheal agent, biofeedback, injectable anal bulking agent, sacral nerve stimulation, anal sphincteroplasty

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10
Q

Sx after stroke: Seizures

A

Incidence: 5-12%
Assessment tool: EEG, MRI
Management: +/- AED

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11
Q

Sx after stroke: Sexual dysfunction

A

Incidence: 50%
Assessment tool: hormonal labs
Management: depression screening, counseling
Controversial to start sildenafil

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12
Q

Sx after stroke: sleep disordered breathing

A

Incidence: 50%
Assessment: Sleep study
Management: wt loss, CPAP

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13
Q

Carbidopa/Levodopa

A

Benefit: bradykinetic sx
Side effects: nausea, somnolence, dizziness, HA, motor fluctuations, dyskinesia, dystonia, cramps

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14
Q

Duopa

A

(enteral suspension of carbidopa/levodopa)
Improves on/off fluctuations, decreases dyskinesia

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15
Q

Apomorphine

A

Improves “off” symptoms
SE: Chest pain drowsiness, dizziness, nausea, falls, yawning

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16
Q

consequences of abruptly stopping Levodopa

A

neuroleptic malignant syndrome, akinetic crisis

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17
Q

Consequence of abruptly stopping dopamine agents

A

anxiety, panic, depression, sweating, nausea, pain , fatigue, dizziness, craving

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18
Q

Pamiprexole and ropinirole

A

Dopamine agent
Benefit: bradykinetic sx and dyskinesia
Side effects: n/v, orthostatic, confusion, sleepy, hallucinations, edema, impulse control disorder

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19
Q

Rotigotine patch

A

Dopamine agent
Same as Pamiprexole

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20
Q

Amantadine

A

Benefit: improves bradykinesia, rigidity and tremor

Side effects: livedo reticularis, ankle edema, hallucinations, confusion, nightmares

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21
Q

Entacapone and Tolcapone

A

COMT inhibitors
Benefit: decrease motor fluctuations and decrease “off” symptoms
Side effects: diarrhea, discolored urine, dyskinesia, hallucinations, orthostasis

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22
Q

Rasagiline and selegiline

A

MAO-B inhibitors
Benefit: decrease motor fluctuations and better UPDRS score
Side effects: nausea, HA, confusion, dyskinesia, psych tox

23
Q

Trihexyphenidyl

A

Anticholinergic
Benefit: for young pt w tremor predominant PD
Side effects: Confusion, hallucinations, urinary retention, tachy

24
Q

Poor prognostic factors: ALS

A

Dz starting with bulbar or respiratory sx
Age>65
malnutrition
Frontotemporal dementia
NIP <40
FVC <50%
impulsivity and decreased judgement

Median survival 20-48mo (die from respiratory failure in 3-5yrs)

25
Q

Poor prognostic factors: MS

A

> 1 neuro system involved at onset
PPMS
celebellar sx
2 attacks in 2 years
high disability in 5 yrs
African American
40yo at age of onset
poor recovery after attack

life expectancy decreased by 7-14 years

26
Q

Poor prognostic factors: ICH

A

GCS <12
Age >80
ICH vol >30ml
Intraventricular hemorrhage
infratentorial origin of hemorrhage

27
Q

Poor prognostic factors: parkinsons

A

increased age
presence of dementia
more severe axial sx

Median survival 6-22yrs

28
Q

Poor prognostic factors: stroke

A

coma, loss of brainstem reflexes
midline shift
High NIHSS score
advanced age
more comorbidities
disabled before stroke
stroke complications
hemorrhagic stroke
low GCS
need for vent
prestroke cognitive impairment

29
Q

Tx of visual hallucinations and paranoid delusions in parkinsons

A

adjust antiparkinson meds
atypical neuroleptics (clozapine, quetiapine)
selective serotonin agonist (pimavabserin)

NO HALDOL

30
Q

Tx sialorrhea

A

chewing gum
botox injection
glycopyrrolate
hyoscyamine
atropine

31
Q

Tx Rhinorrhea in parkinsons

A

ipratropium nasal spray

32
Q

Tx constipation in parkinsons

A

lubiprostone
Miralax

33
Q

Tx acute exacerbation in MS

A

Steroids if sx impair function
Methylpred 1g per day for 5 days

if not responsive then plasma exchange

34
Q

Tx Fatigue in MS

A

amantadine, methylphenidate, modafinil, fampridine, L-carnitine, SSRI, asa

Rehab better than meds

35
Q

Tx depression in MS

A

2/3 pt have depression
2x higher risk of suicide

Desipramine and paroxetine (problem- many SE)

36
Q

Tx pain in MS

A

Primarily neuropathic
TCA, anticonvulsants, SNRI, PT

if severe radiofrequeny rhizotomy

37
Q

Tx urinary incontinence MS

A

timed voiding, fluid restriction
ER oxybutynin and tolterodine

38
Q

Tx for ALS that improve survival

A

Riluzole (glutamate antagonist)
slows progression +83 days

NPPV with BiPAP

+/- on PEG

39
Q

when to start NPPV in ALS

A

VC <50%
presence of orthopnea
NIF<40
MIP <60cm
Nocturnal O2 <88%

40
Q

When to get PEG for ALS

A

+/- on survival benefit

10% wt loss
require >30min to finish meals
symptomatic dysphagia

Not option if VC <30%

41
Q

Conditions to use PEG tubes

A

Head and neck cancer
Acute stroke with dysphagia
ALS
Gastric decompression

42
Q

Leading cause of death MS

A

Infection
(CV, suicide, cancer)

43
Q

Leading cause of death PD

A

aspiration PNA

44
Q

Leading cause of death stroke

A

Early; neuro complication
Late: respiratory and CV

45
Q

Tx agitation in dementia

A

Citalopram
Risperidone (effective but too many side effects: falls, stroke, infection, death)

46
Q

When to use anticholinergic monotherapy for PD?

A

Trihexylphenidyl

Pt <70yo with primarily tremor without significant bradykinesia or gait disturbance

47
Q

Life expectancy after diagnosis of AD

A

4-8 yrs on average

Effected by age of diagnosis

48
Q

Mortality of advanced AD pt after admission to hospital with PNA or hip fx

A

6 mo mortality rate 50%

49
Q

Primary side effects of donepezil

A

n/v, diarrhea, dizziness

Wt loss (rivastigmine and galantamine)

50
Q

Poor prognostic factors in dementia

A

Older age at onset
Male
gait disturbance
Extrampyramidal signs
hx falls
wandering
comorbid conditions

51
Q

tools for predicting 6 mo mortality in end stage dementia

A

The mortality risk index (12 characteristics; limitation in generalization and not fully matching hospice requirements)

Advanced dementia prognostic tool (ADEPT)
- uses clinical and prognostic data related to hospice eligibility
- only looked at nursing home pts
- did not assess for interventions offered

52
Q

Pain assessment tools for advanced dementia

A
  • Pain assessment in advanced dementia (PAINAD)
  • Pain assessment checklist for seniors with limited ability to communicate (PACSLAC)
53
Q

Assessing depression in pt with mild to mod dementia

A

Geriatric Depression scale
Carroll Depression Rating Scale
Cornell Depression Rating Scale

54
Q

Apathy vs. depression

A

Apathy- loss of motivation leading to diminished initiation, lowered interest, decreased social engagement, blunted emotions, lack of insight

unlike depression there is no sx of altered mood

Palliative Care (11 decks)

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