Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BCGP > Neurological disorders > Flashcards

Neurological disorders Flashcards

1
Q

T/F: 30-40% of delirium is preventable

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T/F: Delirium is abrupt onset as opposed to insidious progression like dementia (alzheimers)

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some pharmacological triggers for delirium?

A

Agents with anticholinergic effects:
Antihistamines: H1 and H2
Antidepressants: paroxetine, TCAs
Antipsychotics: typical > atypical
Antispasmodics and muscle relaxants
Antiparkinson: tihexyphenidyl, benztropine

Benzos, meperideine, steroids
*meperidine has metabolite that can affect pts with renal impairment
Withdrawal syndromes with alcohol, sedative hypnotics, and barbituates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

T/F: There are 3 subtypes of delirium

A

T: hyperactive, mixed, hypoactive

Hypoactive seen more in older adults (quietly confused, disoriented, apathetic, sluggishness, lethargic)

*Often misdiagnosed as depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is The CAM assessment tool?

A

Common Assessment Method: for screening and diagnosis and sometimes monitoring of delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

T/F: there is no medication to PREVENT delirium

A

True. Medications used to reduce delirium duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T/F: The approach in managing delirium is to identify cause and remove offending agent and if needed treat pharmacologically for severe agitation with low dose antipsychotics like haloperidol, olanzapine, risperidone, quetiapine

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T/F: Dementia is a major neurocognitive disorder

A

True: sig cognitive decline from a previous level of performance in one or more cognitive domains (more than just memory)

*Decline interferes with functioning in Instrumental activities of daily living (IADL): driving, managing check book AND activities of daily living (ADL): dressing, eating, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the vitamin deficiencies associated with antiseizure medications like phenytoin, carbamazepine, phenobarbital, and primidone?

A

B12 and folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What vitamin deficiencies are associated with dementia?

A

B-12
Folic acid
B-1 (Thiamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the assessment tools used for cognition?

A

MMSE: mini mental state exam
MoCA: montreal concentration assessment
BOMC: blessed orientation memory concentration
SLUMS: st louis university mental status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some assessment tools for depression?

A

Patient health questionaire-9 (PHQ-9)

Geriatric depression scale-15 (GDS-15)

> =5: depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pathological hallmark of Alzheimer’s disease?

A

extracellular beta-amyloid plaques and intracellular neurofibrillary tangles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the three classes of medications used to treat dementia?

A

Acetylcholinesterase inhibitors
NMDA antagonist
Anti-amyloid monoclonal antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the acetylcholinersterase inhinotors?

A

Donepezil, rivastigmine, galantamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the only disease modifying therapy for dementia?

A

Amyloid beta-directed antibody (Aduhelm: aducanumab)

*used of early disease, mild cognitive impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

T/F: Memantine is not used to treat mild to moderate dementia

A

True. Memantine used to treat only moderate to severe dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What allele is associated with dementia?

A

APOE4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the major side effects of the Ach inhibitors, NMDA antagonists like donepezil and memantine respectively?

A

*Opposite of Anticholinergic medications: diarrhea, nausea, vomiting, anorexia, weight loss

CNS: dizziness, headache, insomnia

Donepezil
GI side effects and insomnia.
If GI take at night
If insomnia take in morning

Rivastigmine comes in patch formulation that has less GI side effects but $$$

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why does rivastigmine interact with anticholinergics?

A

Anticholinergics can cause confusion and blunt effects of acetylcholinesterase inhibtors

*acetylcholinesterase breakdown acetylcholine

*anticholinergics block the transmission of acetylcholine in the central and peripheral nervous systems

*acetylcholinerase inhibitors allow for more availability of acetylcholine transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the only NMDA antagonist used in dementia?

A

Memantine

Used only in mod to severe disease
CNS side effects
Dose adjust with renal impairment

22
Q

Why is Aduhelm typically not used for dementia?

A

Very expensive, IV admin q4 weeks, MRI monitoring

Not much data of benefit to justify expense. Clinically impact not clear for use currently.

*Patients on anticoagulants where excluded due to risk of bleeding

23
Q

What is huperzine A?

A

Herbal supplement with MOA similar to ACHE Inhibitors

*active ingredient from chinese club moss, half compound and acts like ACHEI

*May be used to help slow cognitive decline in elderly

24
Q

What is mechanism of NMDA antagonists?

A

Blocks Ca influx on receptors
Too much Ca excites cells too much and cell dies

Reduces excitatory state and attempt to save cells from dying

25
Q

T/F: Efficacy of with ACHEIs should be assessed after 12 weeks of therapy

A

True. Further assessments on a 6 month basis.

Monitor for AE throughout therapy

26
Q

T/F: donepezil available in patch form

A

True. just approved, transdermal 5 or 10mg once a WEEK

27
Q

T/F: verapamil, diltiazem, lancosamide, beta-blockers inc risk for bradycardia and heart block (PR interval prolongation) when used with AChEI

A

True

28
Q

T/F: NSAIDS not recommended use with AChEI due to inc risk for dyspepsia, peptic ulcer disease, gastric bleeding

A

True

29
Q

T/F: AChEI interact with CYP2D6 inhibitors and CYP3A4 inducers

A

True:

CYP2D6 inhibitors: dc tolerability, buproprion, duloxetine, paroxetine, quinidine, cimetidine (dec tolerability)

CYP3A4 inducers: carbamazepine, phenytoin, primidone, rifampin, st johns wort (dec efficacy)

30
Q

What is NUPLAZID (pimavanserin)?

A

Used to treat dementia related behavior

FDA indicated for hallucinations/delusions associated with parkinson/s disease related psychosis

31
Q

When do you stop AChEis and memantine?

A

consensus lacking but:

non adherence
continued deterioration
terminally ill or serious comorbidity
patient or caregiver choice

32
Q

What are some well documented risk for using benzos in older population?

A

*falls
*cog worsening
*paradoxical disinhibition, worsens behavior
*modest inc in risk of development of pneumonia (sedation leading to hypoventilation, reduction in pressure in the lower esophageal sphincter leading to reflux and aspiration

33
Q

T/F: FDA warning on ALL antipyscotics in AD

A

True. if used in AD dementia = off-label!!

*primary cause of mortality with use of Antipsycotics = HF, sudden death, pneuomia
black box warning of inc risk of death

34
Q

T/F: Parkinson’s is diagnosed by motor symptoms

A

True
Resting tremor
Bradykinesia/akinesia
Rigidity

35
Q

What are medications that can cause sub-acute development of parkinsonian symptoms?

A

AP: haloperidol, fluphenazine

Antiemetics: metoclopramide, prochlorperazine

*usually bilateral onset (weeks to months from initiation)

36
Q

T/F: Parkinson/s disease is shortage of dopamine in the brain

A

True

37
Q

T/F: Selegeline IR is goes through first pass metabolism into amphetamine and methamphetamine and can cause insomnia

A

True.

*BID dosing and recommended to take 2nd dose of the day earlier in day to prevent insomnia (by 2pm)

*selegeline ODT bypasses first pass metabolism (buccal)

38
Q

T/F: Safinamide only approved for management of “off” period in PD treatment

A

True. Cannot be used as monotherapy, adjunct only

39
Q

T/F: DHIVY is newly approved formulation of carbidopa/levodopa (25mg/100mg)

A

True. nothing too different, IR formulation.

The different is fractional tablet, can break off lil fragments if dose too high, etc.

40
Q

T/F: Rytary is extended release CD/LD

A

True. capsule with different release or IR and ER inside

Provides more consistent levels, no high peaks

Can be sprinkled for pts with trouble swallowing.

41
Q

T/F: intestinal gel of CD/LD is called DUOPA

A

True. infused during 16 hr period in daytime (J-tube), provides continuous stimulation bypassing stomach

42
Q

T/F: COMT inhibitors are not to be used as monotherapy

A

True. Adjunct only

43
Q

T/F: New medication for adjunct to CD/LD for PD istradefylline (Nourianz)

A

True. once daily dosing

*dose adjusted to higher dose for smokers

*strong 3A4 inhibitors, lower dose
*strong 3A4 inducers, like carbamazepine —> avoid use

*similar adverse effects as other dopaminergic meds except does NOT cause orthostatic hypotension

44
Q

T/F: INbrija (Levodopa) used for rescue medications for “off period” in PD

A

True. Inhalation, onset 15 min, last up to 60 min

*up to 5 doses per day

45
Q

T/F: To manage REM sleep behavior disorder (RBD), use melatonin 3-15 mg 1 hr before sleep and if that does not work: clonazepam 0.5-2mg before sleep

A

True. RBD (screaming, reenacting dreams, etc)

46
Q

What are the main medications in older adults that would lower the seziure threshold?

A

Diphenhydramine
Tramadol
Buproprion
Meperidine
Clozapine
Haloperidol
___
stimulants
lithium
TCA
theophylline
Imipenem
excessive PCN or Cephalosporin use

47
Q

what is seizures

A

seizures is loss of consciousness for a brief period of time

48
Q

What are common target levels of antiepileptic medications?

A

total PHT 10-20
free PHT 1-2
CBZ 4-12
VPA 50-100
LMT 4-18

49
Q

T/F: More than 909% of PHT is bound to protein

A

True

50
Q

T/F: Phenytoin has the ability to induce many hepatic enzymes

A

True
CYP3A4: lurasidone, quetiapine, pimavanserin, donepezil, galantamine, apixaban, methadone, fentanyl, statins, vit D, macrolides, verapamil, diltiazem protease inhibitors, cyclopsorine,

CYP2D6: codeine, morphine, tamoxifen, tramadol, haloperidol, bb blockers, TCAs, donepezil, galantamine

CYP2C9: warfarin, PHT, glipizide

CYP1A2: clozapine, olanzapine, rasagiline, ropinorole

CYP2C19: PPIs, diazepam,PHT

UGTs: LMT, VPA

BCGP (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions