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444-Oncology and Neurology > Peripheral neuropathies > Flashcards

Peripheral neuropathies Flashcards

1
Q

define peripheral neuropathies

A

: group of disorders (100+) that are caused by damage of the nerves of the peripheral nervous system

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2
Q

classification of peripheral neuropathies may be done according to (3)

A

type of affected nerves
number of affected nerves
pathology of affected nerve

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3
Q

____________ means PN that affects one nerve

A

mononeuropathy

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4
Q

____________ means PN that affects many nerves

A

polyneuropathy

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5
Q

____________ means damage to 2 or few separate nerves at the same time asymmetrically

A

mononeuritis multiplex

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6
Q

what pathology affects axons

A

axonopathy

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7
Q

which pathology affects myelin

A

myelinopathy

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8
Q

which pathology affects the cell body

A

ganglionopathy

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9
Q

what is the most common polyneuropathy

A

diabetic neuropathy

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10
Q

what is the most common genetic polyneuropathy

A

charcot-marie-tooth disease

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11
Q

what is the most common mononeuropathy

A

carpal tunnel syndrome

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12
Q

list 3 etiologies for PN

A

mechanical compression, entrapment
trauma
diseases
immune mediated neuronal destruction
genetics
drugs (isoniazid, cisplatin, vincristine,amiodarone, metro, statins)
toxins
unknown

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13
Q

what is wallerian degeneration

A

trauma/ injery o a nerve that causes dysfunction of nerves and muscles distal to it = muscle atrophy

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14
Q

what is segmental demyelination

A

demyelination of neuron but axon function maintained

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15
Q

what is axonal degeneration

A

gradual distal dying of neuron that doesn’t reverse

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16
Q

what is causalgia

A

burning pain due to peripheral nerve injury

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17
Q

what is hyperesthesia
1. abnormal increased sensation to stimuli
2. abnormal increased sensitivity to pain
3. burning pain due to PN injury
4. painful sensation to nonpainful stimulus

A

1

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18
Q

name 3 autonomic sx from PN

A

Due to alteration of sympathetic and/or parasympathetic nervous system function
Anhidrosis, heat intolerance, OH, diarrhea, constipation, incontinence ,ED, cardiac arrhythmias, gastroparesis, esophageal dysmotility
Morbidity due to falls, OH
Severe dysautonomia: ↑ risk for arrhythmias and sudden cardiac death

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19
Q

what is considered acute PN

A

<4wks

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20
Q

what is considered subacute PN

A

4-8wks

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21
Q

what is considered chronic PN

A

> 8wks

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22
Q

name the 6 ways PN may be evaluated

A

history
labs
electrophysiology
imaging
nerve biopsies
pain assessment scales

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23
Q

what are some nonpharm managements for PN

A

Psych support, physio, exercise programs, rehab, surgery in some kinds of mononeuropathies

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24
Q

3 ways to treat immune mediated neuropathies

A

intravenous immunoglobulins (IVIG)
therapeutic plasma exchange
immunomodulators

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25
Q

describe IVIG

A

Intravenous immunoglobulins (IVIG): random antibody decoys that stear attention off bad antibodies

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26
Q

describe TPE

A

extracorporeal process where pt’s blood components (generally plasma) is removed and the rest is returned back to pt with or without replacement fluid

TPE removes plasma → plasma contains plasma proteins → drugs in plasma (esp those bound to plasma proteins) are removed with plasma → drugs that are extensively distributed hide from TPE removal

27
Q

which are more likely to be removed from TPE
1. drugs that are highly protein bound
2. drugs that have a high Vd

A

1

28
Q

after IVIG, how soon can you do TPE

A

2-4wks

29
Q

what immunomodulators may be used in immune med peripheral neuropathies

A

corticosteroids, cyclophosphmide

30
Q

how to treat autonomic neuropathies

A

treat underlying condition - like immune med or diabetes
symptomatic tx for untreatable neuropathies

31
Q

nonpharm OH management

A

maintain fluid intake, slow cautious movements when changing body posture, sit or lie down if it happens, elevate head in sleep, compression stockings

32
Q

pharm options for OH management

A

fludrocortisone
midodrine
sodium chloride tablets
erythropoietin if anemic
desmopressin for those with nocturnal polyuria
BBs for tachycardia

33
Q

what to watch out for with midodrine

A

beware of supine HPTN- space before pt sleeps, but if immobile = fine whenever

34
Q

what can be given if a pt has anemia and OH

A

erythropoetin

35
Q

what can be given if a pt has nocturnal polyuria and OH

A

desmopressin

36
Q

what may be given for postural orthostatic tachycardia sx

A

beta blockers

37
Q

how to treat a hyperactive bladder (2 drugs)

A

tolterodine
oxybutynin

38
Q

how to treat hyperhydrosis

A

anticholinergics

39
Q

define carpal tunnel sx

A

: collection of sx due to pathology in median nerve of the wrist, sx confined to median nerve distribution

40
Q

RF for carpal tunnel

A

obesity, repetitive motions, genetics

41
Q

presentation of carpal tunnel

A

intermittent sx that are associated with spec activities
numbness, tingling, pin, weakness, feeling cold/ hot hnds

42
Q

nonpharm management for carpal tunnel sx

A

avoid/ minimize exacerbating factors, activities with repeated wrist movement, PT/OT, splint, branches

surgical decompression for mod-severe cases

43
Q

when should surgical decompression be recommended for carpal tunnel

A

if sx >2-7 wks despite other treatments

44
Q

what are some pharm managements for carpal tunnel

A

local methylprednisone injection
short course of oral CS (10-30d)

45
Q

T or F: NSAIDs and gabapentin are recommended for carpal tunnel

A

F- no benefit compared to placebo

46
Q

what is the evidence for methylprednisone injection in carpal tunnel sx

A

evidence of LT improvement of up to 1yr = strong recommendation

47
Q

when should sx reduction be seen in using oral CS for carpal tunnel sx

A

2-8wks

48
Q

RF for postherpetic neuralgia

A

> 50yrs old, immunosuppression

49
Q

what is first line tx for elderly post herpetic neurlgia

A

topical lidocaine

50
Q

list the 4 options for postherpetic neuralgia

A

topical lidocaine
topical capsacin
gabapentin, pregabalin
TCAs

51
Q

what is sciatica

A

Pain across path of sciatic nerve
Due to lumbar disc herniation or spinal stenosis

52
Q

where is sciatica usually located? what are the characteristics?

A

unilateral leg pain- more leg pain than lower back pain
numbness, paresthesia, radiation to lower leg

53
Q

managements for sciatica

A

Heat therapy
Continue normal activity, exercise
NSAIDs- for ST pin control
Opioids- ST for severe acute pain
Steroids
Epidural injection: ST pain control
Systemic: possibly ineffective
Gabapentin
Muscle relaxants- weak recommendation
Surgery: decompressive surgery

54
Q

what is TGN

A

Severe, sharp, electric like, brief unilateral pain across the path of 1 or more of the trigeminal nerve divisions

55
Q

RF for TGN

A

female, >50yrs old

56
Q

1st line tx for TGN

A

Carbamazepine or oxcarbamazepine

57
Q

name the 6 add ons/ alts for TGN

A

lamotrigine
gabapentin/ pregabalin
VA
baclofen
botox
phenytoin

58
Q

can topical ophthalmic anesthetics be used for TGN?

A

no, not effective

59
Q

1st line meds for chronic neuropathic pain

A

gabapentin ,pregabalin, TCAs, venlafaxine, duloxetine

60
Q

2nd line meds for chronic neuropathic pain

A

tramadol, opioids

61
Q

3rd line meds for chronic neuropathic pain

A

cannabinoids

62
Q

how often should you assess efficacy of neuropathic pain meds

A

q2-3wks

63
Q

what is an adequtae trial period of meds for neuropathic pain

A

2-3mths

444-Oncology and Neurology (22 decks)

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