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Patho/Pharm 2 > Neuro part 2 > Flashcards

Neuro part 2 Flashcards

1
Q

what is the patho of bacterial meningitis

A

infection of the pia matter and arachnoid villi, the subarachnoid space (space between the two), the ventricular system, and the CSF

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2
Q

what would a lumbar puncture show for bacterial meningitis

A

increased neutrophils, decreased glucose, increased protein

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3
Q

what would a lumbar puncture show for viral meningitis

A

increased lymphocytes (t), normal glucose, slightly increased protein

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4
Q

what is aseptic meningitis

A

usually viral encephalitis; generally limited to meninges (not found in CSF), no pus or exudate

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5
Q

are symptoms more severe in bacterial or viral meningitis

A

bacterial

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6
Q

what is the patho for fungal meningitis

A

fungi enter nervous sytem and produce granuloma/gelantinous masses in the meninges at the base of the brain –> thrombosis, infarction, hydrocephalus, cranial nerve dysfunction (compression)

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7
Q

who is qualified to get meningitis vaccine

A

all children at 1 year & in grade 7

high risk children should also get 2 doses of 4cMenB and quadrivalent Men-C-ACYW q3-5years

adults just get quad

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8
Q

what is the criteria for epilepsy

A
  1. 2 unprovoked seizures occurring >24h apart
  2. 1 unprovoked seizures and a probability of further seizures
  3. a diagnosis of an epilepsy syndrome
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9
Q

how are seizure classified (3 things)

A
  1. onset - focal, generalized, or unknown
  2. aware/unaware
  3. motor/non-motor
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10
Q

what is epilepsy syndrome

A

a complex of clinical features, S&S that together define a distinctive recognizable clinical seizure disorder

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11
Q

what is focal onset

A

starts in cluster of neurons in one hemisphere - manifests as unilateral symptoms, can be aware or non aware

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12
Q

define the following motor manifestations: automatisms, atonic, clonic

A

Automatisms (more or less coordinated, purposeless, repetitive motor activity)
Atonic (sudden loss of muscle tone; can see someone fall; mainly children)
Clonic (focal rhythmic jerking)

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13
Q

define the following motor manifestations: epileptic spasms, hyperkinetic, myoclonic, tonic

A

Epileptic spasms (focal flexions or extensions of arms; flexion of trunk)
Hyperkinetic (pedaling, thrashing activity)
Myclonic (irregular, brief, jerking movements, lasts sec-min, person can be aware or momentary loss of consciousness)
Tonic (sustained focal stiffening)

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14
Q

define the following non motor terms: autonomic, behaviour arrest, cognitive

A

Autonomic (focal autonomic sensations like GI sensations, sense of heat or cold, flushing, pyloerection, palpitations, etc)
Behaviour arrest (cessation of movement & unresponsiveness)
Cognitive (pt reports deficits in language, thinking or assoc higher cortical functions)

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15
Q

define the following non motor terms: emotional, sensory

A

Emotional (emotional changes incl fear, anxiety, anger, laughing, etc)
Sensory (somatosensory, olfactory, visual, auditory, taste, temp, position sensations)

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16
Q

what is generalized onset

A

onset involved both hemispheres (focal can become generalized)

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17
Q

do you use awareness to classify generalized seizures?

A

no - most are unaware, only use motor/non-motor

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18
Q

what do the terms tonic & clonic refer to

A

tonic = limb/neck stiffening, elevation
clonic = sustained rhythmic jerking of limbs on both sies

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19
Q

what is myoclonic

A

in isolation or conjunction with tonic or atonic activity, differs from clonus by being briefer and not regularly repetitive

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20
Q

what is myoclonic-tonic-clonic

A

begin with a few myoclonic jerks followed by tonic-clonic activity

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21
Q

what is tonic-clonic

A

clonic phase –> regularly decreasing frequency of jerks over course, awareness is lost with stiffening & jerking (tonic), may invoke nonspecific feeling of impending seizure

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22
Q

what is myoclonic-atonic

A

brief jerking followed by limp drop

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23
Q

what is an epileptic spasm

A

sudden flexion, extension or mixed of predominantly proximal and truncal muscles (infantile spasms)

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24
Q

what is myoclonic absence

A

rhythmic 3 second myoclonic movements

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25
Q

how are unknown onset seizures classified

A

motor or unclassified

26
Q

what test would you order to evaluate a seizure

A

health hx,
blood & urine tests (glucose, serum Ca, BUN, urine Na, CrCl)
brain imaging (CT, MRI)
CSF exam
EEG

27
Q

what is the most common cause of fever in peds

A

fever (it is benign)

28
Q

what are 2 important considerations with treatment of epilepsy with AEDs

A

do not stop abruptly, monitor plasma levels to monitor for toxicity

29
Q

what is the MOA for phenytoin (dilantin)

A

selective inhibition of Na channels; suppress action potential to suppress hyperactivity

30
Q

what is phenytoin used for

A

all types of seizures except absence seizures (especially effective against clonic tonic)

31
Q

what are AEs for phenytoin

A

nystagmus, ataxia, bone marrow suppression, gingival hyperplasia

32
Q

what are CIs for phenytoin

A

pregnancy, bradycardia, atrioventricular block

33
Q

what is the MOA for fosphenytoin

A

prodrug - converted to phenytoin when metabolized (same MOA)

34
Q

what is fosphenytoin used for

A

all seizures except absence, esp effective in tonic-clonic (same of phenytoin)

35
Q

what is the MOA for carbamazepine (tegretol)

A

similar to phenytoin, reduces Na currents

36
Q

what is carbamazepine used for

A

all seizures except absence

37
Q

what are AEs of carbamazepine

A

vertigo, NV, leukopenia, anemia, thrombocytopenia

SEVERE include SJS, toxic epidermal necrolysis, DRESS

38
Q

what is a CI for carbamazepine

A

pregnancy (increase risk of spina bifida)

39
Q

what is MOA for ethosuximide (zarontin)

A

suppressing Ca influx & suppresses neurons in thalamus

40
Q

what is ethosuximide used for

A

absence seizures

41
Q

what are AEs of ethosuximide

A

NV, decreased appetite/weight loss, drowsiness, dizziness, lethargy (diminish with continued use)

42
Q

what is the preferred method for determining dose of ethosuximide

A

monitor clinical response (NOT plasma drug levels)

43
Q

what is the MOA of phenobarbital

A

long-acting barbiturate (scheduel 4 controlled substance), enhances the effect of GABA (an inhibitory neurotransmitter)

44
Q

what are AEs of phenobarbital

A

drug interactions, sedation, lethargy, depression (widely replaced by newer drugs)

45
Q

what is the MOA of primidone (mysoline)

A

identical to phenobarbital (enhance GABA)

46
Q

what is the MOA of primidone (mysoline)

A

structure identical to phenobarbital, MOA similar to phenytoin –> selective Na channel suppression

47
Q

what is primidisone used for

A

effective against tonic-clonic, simple particle, and complex partial seizures; NOT effective against absence or active seizures

48
Q

what are AEs of primidone

A

sedation, ataxia, dizziness

49
Q

what is the MOA of valproic acid (depakote)

A

mostly unknown, thought to enhance GABA

50
Q

what is valproic acid used for

A

all seizure types

51
Q

what are the AEs of valproic acid

A

can be SEVERE: pancreatitis, severe hepatotoxicity, liver failure, thrombocytopenia, high ammonia levels, teratogenic

52
Q

what is an important consideration for valproic acid related to children?

A

should not be used in combo with any other drugs

53
Q

what is the MOA for levetiracetam (keppra)

A

unkown :)

54
Q

what is keppra used for

A

focal and generalized seizures

55
Q

what are commons AEs of levetiracetam (keppra)

A

drowsiness & asthenia

less side effects & drug interactions

56
Q

what AED should you absolutely never use in pregnancy, even at small doses

A

valproic acid

57
Q

what AEDs are dangerous in pregnancy but can be used if benefits outweigh the risks

A

carbamazepine, phenytoin, phenobarbital

58
Q

what second prescription should pregnant people have if on an AED

A

folic acid

59
Q

how does the ketogenic diet help prevent seizures

A

MOA not understood, ketones and polyunsaturated fats may play role in anti-seizure effect

60
Q

what AEDs are good for absence seizures

A

valproic acid (good for everything); ethosuximide (only good for absence)

Patho/Pharm 2 (7 decks)

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