Neurology II Flashcards
1
Q
State the six major CNS neurotransmitters
A
norepinephrine dopamine serotonin GABA Glutamate substance P
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)
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
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
5
Q
describe the process of neurotransmission
A
- neurotransmitters released at a synapse
- bind to a receptor on the postsynaptic neuron
- stimulate an action potential or not (inhibitory)
- remove the neurotransmitter from the synaptic cleft
6
Q
is acetylcholine excitatory or inhibitory?
A
BOTH; somatic vs parasympathetic
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)
8
Q
neurotransmitters either ___ or ____ after binding
A
removed or recycled
9
Q
COMT, MAO, and cholinesterase are examples of
A
enzymes that degrade neurotransmitters
10
Q
physical dependence creates…
A
tolerance (higher doses needed to yield the same effect)
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
12
Q
what are the diagnoses for abuse and psychological dependence?
A
- spending a lot of time using and recovering from the substance
- using more than intended
- disruption of important activities due to substance use
- compulsive use despite harm
- tolerance
- withdrawal symptoms if without drugs
- unsuccessful efforts to cut down
13
Q
headache is a symptom or sign or diagnosis?
A
symptom (subjective)
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.
15
Q
what is chronic migraine?
A
migraine
16
Q
criteria for migraine
A
more than 15 days in a month for more than 3 months
17
Q
3 common etiologies for migraine
A
- adult women
- childhood
- genetic link
18
Q
patho for migraine?
A
unknown
19
Q
what is the sequelae for migraine?
A
trigeminal nerve irritation –> inflammation within meningeal vasculature
20
Q
two classifications of migraine?
A
without aura: common
with aura: visual disturbances and aura precedes the headache
21
Q
prodrome fatigue irritability (pre-migraine) N&V intense unilateral headache hypersensitivity to stimuli sensory disturbances
are s&s of?
A
migraine
22
Q
treatment for migraine
A
- analgesics (NSAIDS, acetaminophen)
- serotonin agonist
- botox (superficial scalp IM injection)
- adjunct medications (caffeine, antiemetics)
23
Q
how does botox treat migraine?
A
it is an antiinflammatory action that decreases neurotransmitter hyperstimulation
24
Q
definition of psychiatric disorders
A
a change in thoughts, mood, or behavior that interferes with the person’s life
25
how is a psychiatric disorder classified?
on a biological basis (DSM 5)
26
what are the two common symptoms of psychiatric disorders
hallucination, delusion
27
what is hallucination
abnormalities of perception (sensory)
28
in the expected pathway of perception, all sensory info leads to ____, then to the specific _____ region.
thalamus; cortical
e.g.) primary visual cortex for seeing and visual association cortex for interpreting
29
causes of hallucination
1. sensory block --> replaced by stored images
| 2. neuronal dysfunction --> neuronal hyperactivity; pathway dysfunction; disease
30
the sensory block can be caused by
sensory deprivation, sensory dysfunction like blindness
31
neuronal dysfunction can be caused by
drug-induced, pathology like tumors
32
what is delusion
abnormalities of thought
33
patients with delusion have ____ ____ in facts and _____.
false belief and paranoia
34
delusion is caused by _____ and _____ influences
environmental and existential influences
| e.g. education, religion, social experiences, stressors
35
what is psychosis
perceptive loss of reality;symptoms
36
hallucination
delusion
lack of awareness and judgment
mood alternations
are s&s of ?
psychosis
37
etiology of psychosis
```
mental health illnesses
drug side effects/toxicity overdose
electrolyte imbalances
sepsis in elderly*
hospital induced overstimulation (ICU; requires proactive prevention)
```
38
what is schizophrenia
dysfunction of thoughts and language expression
39
schizophrenia is a chronic or acute illness
chronic
40
is familial link significant in schizophrenia?
yes
41
abnormal behavior and movement
| are s&s of?
abnormal behavior and movements
42
three types of abnormal behaviors in schizophrenia
disorganized: disconnected words and thought processes
psychotic (positive symptoms): hallucination, delusion
negative symptoms: lack of motivation/happiness, apathic
43
which behavior in schizophrenia is the most difficult to treat
negative symptoms
44
etiology of schizophrenia
unknown: structural and genetic predisposition
dopamine neurotransmitter theory: dopamine excess
45
how to diagnose schizophrenia?
2 of the s&s and 2 other functional alternation
46
neuroleptics is also known as
antipsychotics
47
goal of antipsychotics
selective D2 dopamine receptor block in the limbic system
| non-selective 5HT, Ach blockade
48
which receptor is the main target of antipsychotics?
Limbic system D2 receptors
49
degree of _____ and ____ affect the success with therapy and create various effects.
antagonism and specificity
50
the side effect of antipsychotics
antagonism in basal ganglia creates extrapyramidal side effects
51
tardive dyskinesia (tongue movement), parkinsonism (rigidity), tremors, restlessness, dystonias (muscle spasm) are side effects of
antipsychotics
52
urinary retention, dry mouth, sexual dysfunction are side effects of
anticholinergic
53
what is a neuroleptic malignant syndrome
a toxic ER reaction associated with the use of antipsychotic agents
54
hyperthermia, unstable BP, diaphoresis, incontinence are side effects of
neuroleptic malignant syndrome
55
typical antipsychotic drugs are _____ sedative than typical drugs
more
56
atypical drugs have high efficacy for ________ symptoms
positive and negative
57
typical drugs have high efficacy for ______ symptoms
positive
58
how long do typical drugs take to improve hallucination and delusion
6 to 8 weeks
59
what is depression
the spectrum of depressive disorders
60
is familial link significant in depression?
yes
61
depression is often ______. (time)
recurrent
62
```
loss of interest in activities
inability to experience pleasure
decreased concentration
sleep alternation
hallucination, delusion
appetite alternations
suicidal ideation
```
are s&s of
depression
63
etiology of depression
neurotransmitter theories (serotonin and norepinephrine)
illnesses
contributing factors (loneliness in elderly)
drug-induced
64
depression happens across _____
lifespan
65
treatment of antidepressants
```
SSRIs
atypical antidepressants (SNRI)
tricyclic antidepressants
MAO inhibitors
non-pharmacological (implants stimulant in brain, counseling)
```
66
what is the first-line drug for antidepressant?
SSRI
67
mechanism of MAO inhibitor?
prevent the breakdown of serotonin, NE, dopamine
68
what is serotonin syndrome
increased serotonin = increased lethargy, sedation, nausea, dry mouth, muscle rigidity, decreased retaining urine
69
side effects of norepi
insomnia, vs effects, anticholinergic effect
70
the onset of action for antidepressants is
slow
71
Lithium (Lithonate) is a
mood stabilizer
72
how does lithium work to treat depressant
increase serotonin and decrease Na cellular influx
=> decrease impulsivity and mood swings
73
side effect of lithium
```
narrow TI
toxicity
high Vd
slow onset of action
compliance
drug to drug interactions
```
74
dementia is a ______ disorder.
neurocognitive disorder
75
in dementia, there is a deficit in _____ and _____ memory and ________ such as judgement or personality change.
short and longterm; higher cortical function
76
how to diagnose dementia?
rule out any drug side effects, depression, metabolic disease, declining sensory perception, brain lesion, infection, anemia
77
is there a direct diagnosis for dementia?
no
78
_____% of all dementia is Alzheimer's disease
64
79
What's the pathology of Alzheimer's disease?
there is a decreased Ach synthesis and accumulation of B-amyloid deposits and protein fibre tangles => creates plaques => cellular necrosis => dysfunction
80
mild forgetfulness --> behavioural changes --> inability to complete ADLs are s&s of
alzheimer's disease
81
is there a cure for Alzheimer's disease
no cure; only increase Ach
82
acetylcholine is made from _____ and ____
choline and acetyl CoA
83
In synaptic cleft, Ach is broken down by
acetylcholinesterase
84
Parkinson's disease is a ________ disorder.
neurodegenerative
85
what is the pathology of parkinson's disease?
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
rigidity, jerking, tremors are s&s of
Parkinson's disease
87
treatment of parkinson's disease
increase dopamine (dopamine agonist)
88
```
end result of
catecholamines
cholinomimetics
anticholinergics
adrenergic antagonists
```
catecholamines=stimulate SNS
cholinomimetics= stimulate PNS
anticholinergics= decrease PNS= stimulate SNS
adrenergic antagonists= inhibit adrenergic = decrease SNS
89
catecholamines are also known as
adrenergics (epi, dopamine)
90
cholinomimetics are also known as
muscarinics (Ach)
91
the function of nicotinic agonist
activate Ach at nicotinic receptors
92
increased BP, peripheral vasoconstriction, decreased GI activity
are s&s of
nicotinic agonist
93
what receptors do catecholamines act on?
catecholamines target alpha a& 2 and beta 1&2 adrenergic receptors
94
catecholamines are classified as
direct-acting & indirect-acting & both
95
what is the function of indirect-acting catecholamines
enhance release
96
* 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
catecholamines
97
function of amphetamines
Catecholamines that increase focus and stimulate RAS
98
side effect of amphetamines
weight loss, tachycardia
99
what is crystal meth
stimulants; street drug of amphetamines; dose up to 200x higher than TI
100
anticholinergics is also known as
antimuscarinics
101
how does anticholinergics work?
block cholinergic receptors
102
```
atropine
atrovent
ditropan
scopolamine
nicotinic antagonists
are drugs of
```
anticholinergics
103
what do these drugs treat?
```
atropine
atrovent
ditropan
scopolamine
nicotinic antagonists
```
atropine: bradycardia
atrovent: asthma
ditropan: incontinence
scopolamine: vomiting
104
nicotinic antagonists are also known as
neuromuscular blockers
105
the muscarinic receptor is involved in
parasympathetic
106
the adrenergic receptor is involved in
sympathetic
107
the nicotinic receptor is involved in
motor neuron
108
acetylcholine is received in
motor neuron and parasympathetic neurons
109
norepinephrine is received in
sympathetic neurons
110
mechanism of scopolamine
anticholinergic (Ach block)
111
does scopolamine cross BBB in CNS
yes
112
what is scopolamine used for therapeutically
nausea and vomiting
113
dilated pupils, blurred vision, increased sensitivity to light, confusion, amnesia, sedation, and unconsciousness
are s&s of high doses of
scopolamine
114
what is devil's breath?
abusive use of scopolamine for criminal purposes
115
mechanism of curare
anticholinergic
116
curare is specific mainly to which system
somatic nervous system (neuromuscular blocking agent)
117
how can curare be toxic?
lead to respiratory muscle paralysis
118
botulism is infection with ________
clostridium botulinum (gram +, anaerobic)
119
mechanism of action of botulism
it releases a neurotoxin that inhibits Ach at somatic neuromuscular junctions= paralysis (similar to curare)
120
how to prevent botulism?
with preservatives (add Nitrite: potassium nitrate salt)
121
cholinomimetics stimulate _______
acetylcholine
122
Propranolol (beta 1 & high doses beta 2)
Metoprolol (beta 1; high doses beta 2)
Labetalol
are examples of ___________
adrenergic antagonists that decrease adrenergic effect (treat hypertension)
123
galantamine & neostigmine ______ prevent the breakdown of Ach
indirectly
124
galantamine and neostigmine are used to treat
gala: Alzheimer’s disease
neo: Myasthenia gravis
