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RC Study > Neurological disorders other than dementia > Flashcards

Neurological disorders other than dementia Flashcards

1
Q

ALS

A
  • life expectancy 2-4 years from symptom onset
  • Spinal variant:
    • early tetraparesis
    • late onset cranial nerve dysfunction
  • Bulbar variant:
    • 20%
    • speech and swallowing
    • progressive muscle weakness
    • neurobehaviour sx (apathy, disinhibition)
  • decreaesd mobility, loss of speech and swallowing, dyspnea, dysphagia, mucous, muscle cramps, insomnia
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2
Q

ALS : Respiratory insufficiency

A
  • Influenza and pneumococcal vax
  • 02 not recommended - hypercarbia
  • nocturnal NIPPV for headache and daytime somnolence
  • 24 hour NIPPV as disease progresses
  • survival effect of NIPV
  • withdrawal of NIPPV - palliative sedation
  • tracheostomy extends life, but large burden of care
  • dyspnea tx opioids
  • anxiety : benzos
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3
Q

ALS : Mucous congestion of airways

A
  • impaired coughing
  • mucolytics : NAC
  • beta receptor agonist, nebulized saline, furosemide
  • cough assist device
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4
Q

ALS: malnutrition

A
  • Dysphagia
  • hypermetabolism
  • discuss feeding tube placement early
  • SLP
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5
Q

ALS : Sialorrhea

A
  • drooling common result of swallowing deficits
  • SLP
  • amitiptyline
  • hyoscine hydrobromide (scopalamine) patch
  • atropine drops orally
  • glycopyrrolate
  • botox injection in salivary glands
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6
Q

ALS: Spasticity and muscle cramps

A
  • common in primary motor neuron disease
  • physio
  • baclofen
  • tizanadine
    • many SE of meds: athenia and weakness
  • Nabiximols - synthetic cannabinoid
  • botox for focal spasticity
  • Muscle cramps:
    • Levetiracetam (keppra)
    • quinidine
    • phenytoin
    • carbamazepine
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7
Q

ALS: Insomnia and fatigue

A
  • muscle cramps, pain, respiratory distress, depression
  • sleep: amitriptyline, mirtazapine, zolpidem
  • fatigue : modafinil, ritalin
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8
Q

ALS: Pseudobulbar effects

A
  • corticobulbar degeneration
  • inappropriate laughter or crying incongruent to patient’s mood
  • Dextromethorphan and quinidine
  • SSRI (citalopram, amitriptyline)
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9
Q

ALS: Depression, suicidality and death

A
  • common
  • increased desire for hastened death
  • psychosocial support
  • most patients die a sudden, non violent death, often while sleeping
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10
Q

Parkinson’s disease : Motor symptoms

A
  • bradykinesia, muscle rigidity, dystonia, gait instability, tremor
  • carbidopa/levodopa
  • amantadine
  • botulism
  • analgesics for pain
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11
Q

Parkinson’s: Autonomic dysfunction

A
  • Orthostatic hypotension
    • Multi system atrophy most common
    • reduction of L dopa
    • compression stockings
    • increased sodium
    • fludrocortisone
    • midodrine
  • urinary urgency and incontinence
    • oxybutynin, tolteridine
    • botox
  • increased sweating, delayed gastric emptying, constipation, sialorrhea
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12
Q

Parkinson’s : Psychiatric symptoms

A
  • psychosis, hallucinations, delusions
  • dose reduction of l-dopa helps
  • stop anticholingerics, amandatine
  • very low dose atypical neuroleptics (seroquel)
  • personality and mood changes common
  • subcortical dementia
    • cholinesterase inhibitors modestly effective

Depression, panic attacks

  • SSRIs
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13
Q

Parkinson’s: Sleep disorders

A
  • restless legs syndrome
    • low dose dopamine agonists at bedtime
    • valproic acid, gabapentin, benzodiazepines
  • Rapid eye movement sleep disorder
    • may harm themselves or partner
    • clonazpeam
    • melatonin
    • dopaminergic and ach drugs worsen this
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14
Q

Atypical parkinsonian disorders:

PSP, corticobasal degeration, multiple system atrophy, dementia with lewy bodies

A
  • Parkinson-like symptoms that do not respond to antiparkinsonian drugs
  • much shorter prognoses
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15
Q

Atypical Parksinoniah disorders: Management

A
  1. Motor function
  • carbidopa/levodopa
  • amantadine, imipramine
  • become ineffective over time
  1. Neck and back pain from rigidty and spasm
  • botox
  • physio
  • analgesics
  • myoclonus - benzos
  1. Dysautonomia
  • orthostatic hypotension
    • reduce dopamine agonist
    • compression stockings, increased Na and water
    • midodrine, fludrocortisone
  • urinary incontinence
    • oxybutynin, tolteridone, botox
  1. Dysarthria/dysphagia
    * feeding tube placement individual
  2. Psychiatric symptoms
  • personality and mood changes
  • DLB : executive function, but not memory
  • subcortical dementia
  1. Sleep disorders
    * REM disorder -clonazepam, melatonin
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16
Q

Terminal phase of parkinsons/ atypical parkinson’s

A
  • Pneumonia
  • bradykinesia increases dramatically
  • seizures
  • eyes wide open but unable to control
  • extensive stiffness
17
Q

Multiple sclerosios

A
  • inflammatory auto immune disorder
  • incurable
  • variable prognosis
  • sx: difficulty using arms or legs, fatigue, spasticity
18
Q

Symptom control in Neurodegenerative disease :

dyspnea related anxiety

A
  • fast acting benzos
  • lorazepam 0.5-1mg q4h prn
19
Q

Symptom control in neurodegenerative diseases: Fatigue

A
  • SSRI citalopram 20 mg po od
  • modafinil 100 mg po od
  • methylphenidate 5 mg po bid
20
Q

Symptom control in Neurodegenerative disease :

Muscle cramps

A
  • quinidine sulphate
  • baclofen
21
Q

Symptom control in neurodegnerative disease :

Pain

A
  • tilidine, metamizole, tramadol, morphine etc
  • TCA, SNRI
22
Q

Symptom management in neurodegenerative disorder:

Pseudobulbar affect

A
  • dextromethorphan 20 mg po od plus quinidine 10 mg po od
  • SSRI
23
Q

Symptom management in neurodegen :

Pseudohypersalivation

A
  • sage tea
  • amitriptyline
  • scopolamine patch
  • botox to salivary glands
  • salivary galnd radiotherapy
24
Q

Symptom control neurodegen :

Psychosis, agitation, irritability, dysphoria

A
  • non pharm : calm, quiet environment
  • Quetiapine 25-50 mg po od
25
Q

Symptom control neurodegen :

REM sleep behaviour disorder

A
  • Clonazepam 0.25-1 mg po qhs)
  • Melatonin 3-12 mg
26
Q

Symptom control neurodegen :

Respiratory failure

A
  • NIPPV
  • tracheostomy
  • opioids
27
Q

Symptom control neurodegen :

rigidity, bradykinesia, akinesia

A
  • Amantadine 600 mg po/iv
    • dopamine agonist, NMDA antagonist, nicotinic agonist
  • morphine
  • midazolam
  • rotigotine patch
28
Q

Symptom control neurodegen :

Sleeplessness

A
  • zopiclone, zolpidem
  • amitriptyline 25 mg po
  • Mirtazapine
  • Quetiapine 25 mg po
29
Q

Symptom control neurodegen disorder :

Spasticity

A
  • Physio
  • Baclofen
  • Tizanidine
  • Botox
30
Q

Symptom control neurodegen :

Thick secretions

A
  • hydration
  • mucolytics (NAC, ambroxol)
  • Beta antagonists
  • nebulized saline, cough assist device, humidification

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