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NURS216B > Neurology II > Flashcards

Neurology II Flashcards

1
Q

State the six major CNS neurotransmitters

A 
norepinephrine
dopamine
serotonin
GABA
Glutamate
substance P
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2
Q 
state whether they are excitatory or inhibitory:
norepinephrine
dopamine
serotonin
GABA
Glutamate
substance P
A

norepinephrine: e (drive motivation)
dopamine: e (reward pathway)
serotonin: i (calming mediator)
GABA: i (increase Cl influx=decreased cell activity)
Glutamate: e (NMDA receptor found on neuron, memory learning)
substance P: e (pain transmitter)

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3
Q 
when # of neurotransmitters are HIGH,
norepinephrine
dopamine
serotonin
GABA
Glutamate
substance P
A

norepinephrine: anxiety, stress
dopamine: anxiety, psychosis
serotonin: mood swings
GABA: lethargy, confusion, amnesia, sedation
Glutamate: focus, anxiety
substance P: pain sensation

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4
Q 
when # of neurotransmitters are LOW,
norepinephrine
dopamine
serotonin
GABA
Glutamate
substance P
A

norepinephrine: depression, lethargy
dopamine: depression lethargy
serotonin: depression, OCD, mood swings
GABA: anxiety, insomnia
Glutamate: low focus, poor retention
substance P

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5
Q

describe the process of neurotransmission

A
  1. neurotransmitters released at a synapse
  2. bind to a receptor on the postsynaptic neuron
  3. stimulate an action potential or not (inhibitory)
  4. remove the neurotransmitter from the synaptic cleft
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6
Q

is acetylcholine excitatory or inhibitory?

A

BOTH; somatic vs parasympathetic

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7
Q

what electrolytes are seen in depolarization?

A

K+ in when going + positive (-96mV)
Na+ in when going + positive (depolarization)
K+ and Cl- out when reaching the top （最高點）
Ca2+ in and K+ out when 52mV (維持）
K+ out when going - negative (repolarization)

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8
Q

neurotransmitters either ___ or ____ after binding

A

removed or recycled

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9
Q

COMT, MAO, and cholinesterase are examples of

A

enzymes that degrade neurotransmitters

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10
Q

physical dependence creates…

A

tolerance (higher doses needed to yield the same effect)

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11
Q

how many DSM5 diagnoses are needed in the same 12 month period to be qualified for abuse and psychological dependence?

A

3 or more

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12
Q

what are the diagnoses for abuse and psychological dependence?

A
  1. spending a lot of time using and recovering from the substance
  2. using more than intended
  3. disruption of important activities due to substance use
  4. compulsive use despite harm
  5. tolerance
  6. withdrawal symptoms if without drugs
  7. unsuccessful efforts to cut down
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13
Q

headache is a symptom or sign or diagnosis?

A

symptom (subjective)

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14
Q

how to treat patients with headaches?

A

treat the cause; if unknown, do not treat

rule out pathology & diagnosis like fatigue, dehydration, etc.

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15
Q

what is chronic migraine?

A

migraine

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16
Q

criteria for migraine

A

more than 15 days in a month for more than 3 months

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17
Q

3 common etiologies for migraine

A
  1. adult women
  2. childhood
  3. genetic link
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18
Q

patho for migraine?

A

unknown

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19
Q

what is the sequelae for migraine?

A

trigeminal nerve irritation –> inflammation within meningeal vasculature

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20
Q

two classifications of migraine?

A

without aura: common

with aura: visual disturbances and aura precedes the headache

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21
Q 
prodrome fatigue
irritability (pre-migraine) 
N&V
intense unilateral headache
hypersensitivity to stimuli
sensory disturbances

are s&s of?

A

migraine

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22
Q

treatment for migraine

A
  1. analgesics (NSAIDS, acetaminophen)
  2. serotonin agonist
  3. botox (superficial scalp IM injection)
  4. adjunct medications (caffeine, antiemetics)
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23
Q

how does botox treat migraine?

A

it is an antiinflammatory action that decreases neurotransmitter hyperstimulation

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24
Q

definition of psychiatric disorders

A

a change in thoughts, mood, or behavior that interferes with the person’s life

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25
Q

how is a psychiatric disorder classified?

A

on a biological basis (DSM 5)

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26
Q

what are the two common symptoms of psychiatric disorders

A

hallucination, delusion

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27
Q

what is hallucination

A

abnormalities of perception (sensory)

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28
Q

in the expected pathway of perception, all sensory info leads to ____, then to the specific _____ region.

A

thalamus; cortical

e.g.) primary visual cortex for seeing and visual association cortex for interpreting

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29
Q

causes of hallucination

A
  1. sensory block –> replaced by stored images

2. neuronal dysfunction –> neuronal hyperactivity; pathway dysfunction; disease

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30
Q

the sensory block can be caused by

A

sensory deprivation, sensory dysfunction like blindness

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31
Q

neuronal dysfunction can be caused by

A

drug-induced, pathology like tumors

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32
Q

what is delusion

A

abnormalities of thought

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33
Q

patients with delusion have ____ ____ in facts and _____.

A

false belief and paranoia

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34
Q

delusion is caused by _____ and _____ influences

A

environmental and existential influences

e.g. education, religion, social experiences, stressors

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35
Q

what is psychosis

A

perceptive loss of reality;symptoms

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36
Q

hallucination
delusion
lack of awareness and judgment
mood alternations

are s&s of ?

A

psychosis

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37
Q

etiology of psychosis

A 
mental health illnesses
drug side effects/toxicity overdose
electrolyte imbalances
sepsis in elderly*
hospital induced overstimulation (ICU; requires proactive prevention)
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38
Q

what is schizophrenia

A

dysfunction of thoughts and language expression

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39
Q

schizophrenia is a chronic or acute illness

A

chronic

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40
Q

is familial link significant in schizophrenia?

A

yes

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41
Q

abnormal behavior and movement

are s&s of?

A

abnormal behavior and movements

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42
Q

three types of abnormal behaviors in schizophrenia

A

disorganized: disconnected words and thought processes
psychotic (positive symptoms): hallucination, delusion
negative symptoms: lack of motivation/happiness, apathic

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43
Q

which behavior in schizophrenia is the most difficult to treat

A

negative symptoms

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44
Q

etiology of schizophrenia

A

unknown: structural and genetic predisposition

dopamine neurotransmitter theory: dopamine excess

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45
Q

how to diagnose schizophrenia?

A

2 of the s&s and 2 other functional alternation

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46
Q

neuroleptics is also known as

A

antipsychotics

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47
Q

goal of antipsychotics

A

selective D2 dopamine receptor block in the limbic system

non-selective 5HT, Ach blockade

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48
Q

which receptor is the main target of antipsychotics?

A

Limbic system D2 receptors

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49
Q

degree of _____ and ____ affect the success with therapy and create various effects.

A

antagonism and specificity

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50
Q

the side effect of antipsychotics

A

antagonism in basal ganglia creates extrapyramidal side effects

51
Q

tardive dyskinesia (tongue movement), parkinsonism (rigidity), tremors, restlessness, dystonias (muscle spasm) are side effects of

A

antipsychotics

52
Q

urinary retention, dry mouth, sexual dysfunction are side effects of

A

anticholinergic

53
Q

what is a neuroleptic malignant syndrome

A

a toxic ER reaction associated with the use of antipsychotic agents

54
Q

hyperthermia, unstable BP, diaphoresis, incontinence are side effects of

A

neuroleptic malignant syndrome

55
Q

typical antipsychotic drugs are _____ sedative than typical drugs

A

more

56
Q

atypical drugs have high efficacy for ________ symptoms

A

positive and negative

57
Q

typical drugs have high efficacy for ______ symptoms

A

positive

58
Q

how long do typical drugs take to improve hallucination and delusion

A

6 to 8 weeks

59
Q

what is depression

A

the spectrum of depressive disorders

60
Q

is familial link significant in depression?

A

yes

61
Q

depression is often ______. (time)

A

recurrent

62
Q 
loss of interest in activities
inability to experience pleasure
decreased concentration
sleep alternation
hallucination, delusion
appetite alternations
suicidal ideation

are s&s of

A

depression

63
Q

etiology of depression

A

neurotransmitter theories (serotonin and norepinephrine)
illnesses
contributing factors (loneliness in elderly)
drug-induced

64
Q

depression happens across _____

A

lifespan

65
Q

treatment of antidepressants

A 
SSRIs
atypical antidepressants (SNRI)
tricyclic antidepressants
MAO inhibitors
non-pharmacological (implants stimulant in brain, counseling)
66
Q

what is the first-line drug for antidepressant?

A

SSRI

67
Q

mechanism of MAO inhibitor?

A

prevent the breakdown of serotonin, NE, dopamine

68
Q

what is serotonin syndrome

A

increased serotonin = increased lethargy, sedation, nausea, dry mouth, muscle rigidity, decreased retaining urine

69
Q

side effects of norepi

A

insomnia, vs effects, anticholinergic effect

70
Q

the onset of action for antidepressants is

A

slow

71
Q

Lithium (Lithonate) is a

A

mood stabilizer

72
Q

how does lithium work to treat depressant

A

increase serotonin and decrease Na cellular influx

=> decrease impulsivity and mood swings

73
Q

side effect of lithium

A 
narrow TI
toxicity
high Vd
slow onset of action
compliance
drug to drug interactions
74
Q

dementia is a ______ disorder.

A

neurocognitive disorder

75
Q

in dementia, there is a deficit in _____ and _____ memory and ________ such as judgement or personality change.

A

short and longterm; higher cortical function

76
Q

how to diagnose dementia?

A

rule out any drug side effects, depression, metabolic disease, declining sensory perception, brain lesion, infection, anemia

77
Q

is there a direct diagnosis for dementia?

A

no

78
Q

_____% of all dementia is Alzheimer’s disease

A

64

79
Q

What’s the pathology of Alzheimer’s disease?

A

there is a decreased Ach synthesis and accumulation of B-amyloid deposits and protein fibre tangles => creates plaques => cellular necrosis => dysfunction

80
Q

mild forgetfulness –> behavioural changes –> inability to complete ADLs are s&s of

A

alzheimer’s disease

81
Q

is there a cure for Alzheimer’s disease

A

no cure; only increase Ach

82
Q

acetylcholine is made from _____ and ____

A

choline and acetyl CoA

83
Q

In synaptic cleft, Ach is broken down by

A

acetylcholinesterase

84
Q

Parkinson’s disease is a ________ disorder.

A

neurodegenerative

85
Q

what is the pathology of parkinson’s disease?

A

there is an accumulation of Lewy bodies and destruction of dopamine neurons
=> reduced dopamine transmission in basal ganglia = inability to filter out extra movements and focus purposeful movement

86
Q

rigidity, jerking, tremors are s&s of

A

Parkinson’s disease

87
Q

treatment of parkinson’s disease

A

increase dopamine (dopamine agonist)

88
Q 
end result of
catecholamines
cholinomimetics
anticholinergics
adrenergic antagonists
A

catecholamines=stimulate SNS
cholinomimetics= stimulate PNS
anticholinergics= decrease PNS= stimulate SNS
adrenergic antagonists= inhibit adrenergic = decrease SNS

89
Q

catecholamines are also known as

A

adrenergics (epi, dopamine)

90
Q

cholinomimetics are also known as

A

muscarinics (Ach)

91
Q

the function of nicotinic agonist

A

activate Ach at nicotinic receptors

92
Q

increased BP, peripheral vasoconstriction, decreased GI activity
are s&s of

A

nicotinic agonist

93
Q

what receptors do catecholamines act on?

A

catecholamines target alpha a& 2 and beta 1&2 adrenergic receptors

94
Q

catecholamines are classified as

A

direct-acting & indirect-acting & both

95
Q

what is the function of indirect-acting catecholamines

A

enhance release

96
Q
  • Norepinephrine (beta 2)
  • Epi (alpha+beta)
  • Dobutamine, Dopamine (beta 1)
  • Ventolin (beta2)
  • Serevent (beta 2)
  • Ephedrine, Phenylephrine (anti-secretions) (alpha)
  • Amphetamines: Concerta, Ritalin (ADHD tx)

are drugs of

A

catecholamines

97
Q

function of amphetamines

A

Catecholamines that increase focus and stimulate RAS

98
Q

side effect of amphetamines

A

weight loss, tachycardia

99
Q

what is crystal meth

A

stimulants; street drug of amphetamines; dose up to 200x higher than TI

100
Q

anticholinergics is also known as

A

antimuscarinics

101
Q

how does anticholinergics work?

A

block cholinergic receptors

102
Q 
atropine
atrovent
ditropan
scopolamine
nicotinic antagonists
are drugs of
A

anticholinergics

103
Q

what do these drugs treat?

atropine
atrovent
ditropan
scopolamine
nicotinic antagonists
A

atropine: bradycardia
atrovent: asthma
ditropan: incontinence
scopolamine: vomiting

104
Q

nicotinic antagonists are also known as

A

neuromuscular blockers

105
Q

the muscarinic receptor is involved in

A

parasympathetic

106
Q

the adrenergic receptor is involved in

A

sympathetic

107
Q

the nicotinic receptor is involved in

A

motor neuron

108
Q

acetylcholine is received in

A

motor neuron and parasympathetic neurons

109
Q

norepinephrine is received in

A

sympathetic neurons

110
Q

mechanism of scopolamine

A

anticholinergic (Ach block)

111
Q

does scopolamine cross BBB in CNS

A

yes

112
Q

what is scopolamine used for therapeutically

A

nausea and vomiting

113
Q

dilated pupils, blurred vision, increased sensitivity to light, confusion, amnesia, sedation, and unconsciousness
are s&s of high doses of

A

scopolamine

114
Q

what is devil’s breath?

A

abusive use of scopolamine for criminal purposes

115
Q

mechanism of curare

A

anticholinergic

116
Q

curare is specific mainly to which system

A

somatic nervous system (neuromuscular blocking agent)

117
Q

how can curare be toxic?

A

lead to respiratory muscle paralysis

118
Q

botulism is infection with ________

A

clostridium botulinum (gram +, anaerobic)

119
Q

mechanism of action of botulism

A

it releases a neurotoxin that inhibits Ach at somatic neuromuscular junctions= paralysis (similar to curare)

120
Q

how to prevent botulism?

A

with preservatives (add Nitrite: potassium nitrate salt)

121
Q

cholinomimetics stimulate _______

A

acetylcholine

122
Q

Propranolol (beta 1 & high doses beta 2)
Metoprolol (beta 1; high doses beta 2)
Labetalol

are examples of ___________

A

adrenergic antagonists that decrease adrenergic effect (treat hypertension)

123
Q

galantamine & neostigmine ______ prevent the breakdown of Ach

A

indirectly

124
Q

galantamine and neostigmine are used to treat

A

gala: Alzheimer’s disease
neo: Myasthenia gravis

NURS216B (6 decks)

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