Pharmacology in neurorehabilitation Flashcards
Describe the requirements for neurotransmitter classification.
Neurotransmitters must be synthesized by neurons, present in pre-synaptic vesicles, have regulatory mechanisms, have specific receptors, and show effects when provided artificially.
Explain the process of dopamine (DA) re-uptake.
Dopamine is released in the synapse, binds to pre-synaptic receptors (D2/D3), which causes the opening of the pre-synaptic DA transporter for re-uptake.
How can medications affect dopamine levels in the synapse?
Medications can block the pre-synaptic receptor, increasing the quantity of dopamine in the synapse, which enhances binding to post-synaptic receptors, thereby increasing motivation, energy, awakening, and attention.
What is the difference between dopamine re-uptake and serotonin (SE) & norepinephrine (NE) re-uptake?
Dopamine re-uptake requires binding to a pre-synaptic receptor to open the transporter, while serotonin and norepinephrine re-uptake do not require this binding.
Identify the main receptor sites for dopamine (DA).
D1: Prefrontal cortex, Basal nuclei, Amygdala, Hippocampus, Hypothalamus;
D2: Basal nuclei, VTA, Entorhinal cortex, Hypothalamus;
D3: Amygdala, Hippocampus, OFC, mPFC;
D4: Prefrontal cortex, Hypothalamus, Brainstem;
D5: Hippocampus, Thalamus.
Describe the key pathways associated with dopamine (DA).
The mesocortical pathway is involved in goal-directed behavior, attention, and motivation; the mesolimbic pathway is associated with pleasure and emotional processes; the nigrostriatal pathway regulates movement, attention, and adaptation.
Define the role of the mesocortical pathway in dopamine function.
The mesocortical pathway is crucial for goal-directed behavior, attention, and motivation.
What emotional processes are influenced by the mesolimbic pathway?
The mesolimbic pathway influences pleasure and emotional processes.
What is the nigrostriatal pathway responsible for?
The nigrostriatal pathway is responsible for regulating movement, attention, and adaptation.
Describe the primary functions of serotonin (5-HT).
Serotonin modulates mood, anxiety and impulsivity, perception of pain, and memory; influences anger, aggression, and fear; affects appetite and sexuality; and has an indirect role in motor control and cerebellar function.
Identify the location of norepinephrine (NE) production in the brain.
Norepinephrine is located in the locus coeruleus.
What does norepinephrine (NE) ?
Norepinephrine regulates the sleep-wake cycle, influences feeding behavior, and is involved in attention and memory consolidation. Closely related to stress
During stress :
- Trigger flight or fight response
- Incr. alertness & arousal
- Incr. attention & vigilance
- Incr. BP & HR
Define the role of GABA in the nervous system.
GABA is the main inhibitory neurotransmitter, synthesized from glutamate, and plays a role in preventing neuronal over-excitation.
What is the primary function of glutamate in the brain?
Glutamate is the primary excitatory neurotransmitter and is involved in cognition and memory consolidation.
List the common side effects of diuretics like mannitol.
Common side effects include decreased
- visual acuity
- muscle pain
- altered thirst sensation
- limited urination
- postural hypotension
- general weakness.
What are the adverse effects associated with the use of diuretics?
Adverse effects can include
- chest pain
- dry cough
- severe dehydration
- decreased consciousness
- respiratory gas exchange issues
- renal failure
- seizures
- fever
How should clinicians monitor patients on diuretics?
Clinicians should monitor:
- joint stability due to potential swelling
- assess skin elasticity for dehydration
- and consider the timing of physical therapy due to orthostatic hypotension.
What is the primary purpose of anticonvulsants in neurorehabilitation?
The primary purpose of anticonvulsants is seizure prevention and activity reduction.
Explain the importance of anticonvulsants during the acute phase of treatment.
Anticonvulsants are important in the acute phase to reduce seizure risk and promote healing through activity reduction.
What are the common side effetcs of Anticonvulsants?
- Dizziness
- Diplopia
- Blurred vision
- Headache
- Nausea
- Insomnia
- Ataxia
- Weight loss
What are the serious adverse effects of the anticonvulsants?
- PR interval prolongation
- Atrial fibrillation
- Psychosis
- Stevens-Johnson syndrome
- Hepatic failure or multiorgan failure
- Heat stroke
Describe the mechanism of action for barbiturates like Pentobarbital Sodium.
Barbiturates work by potentiating GABA, which leads to sedation.
What’s the goal of using barbiturates?
It’s a “sedation” medication.
It reduces the activity and heavy cognitive load, leading to promote healing & manage pain.
List common side effects of barbiturates.
Common side effects include:
- mental confusion
- hallucinations
- agitation
- somnolence
- bradycardia
- weakness
- decr. HR
Identify adverse effects associated with barbiturates.
Adverse effects can include:
- severe dizziness
- balance impairment
- dyskinesia
- hyperreflexia
- vomiting
- sleep disturbances.
Hyperkinetic symptoms in general (eg: tremor)
How should orientation be assessed in patients taking barbiturates?
Orientation should be assessed in terms of time, place, and person.
When is it best to assess a patient’s orientation taking barbiturates?
At the end of the effects of medications
What clinical considerations should be taken when administering barbiturates?
Consider :
- timing treatments based on medication effects
- monitor sleep patterns, to avoid day sleeping, talk about sleep hygiene
- ensure safety during position changes and due to sonolence
- /!/ IF TRIO Somnolence+ Hallucinations + vomiting => Might vomitate & strangle with it, need to sleep on the side
Explain the mechanism of action for calcium channel blockers like Nimodipine.
Calcium channel blockers inhibit smooth muscle activation, reduce vasoconstriction, and lower blood pressure.
What are the side effects of calcium channel blockers?
Side effects include:
- vision disturbances
- chest pain
- confusion
- somnolence
- bradycardia
- general weakness.
What adverse effects can occur with calcium channel blockers?
Adverse effects may include:
- severe dizziness
- balance loss
- movement disorders
- vomiting
- sleep pattern disruption
How should bladder function be monitored in patients taking calcium channel blockers?
Bladder function should be monitored for potential incontinence due to inhibition of smooth muscle activation due to medication
What is the treatment duration for SSRIs?
The treatment duration for SSRIs typically ranges from 3 to 8 weeks.
Define the mechanism of action for SSRIs.
SSRIs impair serotonin reuptake, increasing serotonin levels in the brain.
=> Decrease symptoms of depression & anxiety
What notable side effect do SSRIs have on brain-derived neurotrophic factor (BDNF)?
SSRIs increase the release of brain-derived neurotrophic factor (BDNF).
Describe the neuromuscular symptoms of serotonin syndrome.
Neuromuscular symptoms include:
- ocular myoclonia
- hyperreflexia
- tremor.
What happens in case of overactivity of SE in the brain? What could cause overactivity?
=> Serotonin syndrom
- Due to Incr. of SE due to SSRI combined with other medication that incr. SE levels
What happens in case of SSRI discontinuation?
Withdrawal syndrome
What are the main symptoms of a serotonin syndrome
- Neuromuscular sympt : Occular myoclonia, Tremor, Hyperreflexia
- Cognitive sympt : Agitation, Attention deficit, WM & reasoning deficit
- Autonomic sympt : Hypertension, Tachycardia, sweating, pupil dilatation
What cognitive symptoms are associated with serotonin syndrome?
Cognitive symptoms include:
- attention deficit
- working memory & reasoning deficit
- agitation.
Describe the autonomic symptoms associated with serotonin syndrome.
-Hypertension
- tachycardia
- pupil dilation
- Sweating
What are the symptoms of a SSRI withdrawal syndrome?
- Dizziness
- Sleep disturbance
- Tremor
- Sweating
- Nausea
- “Brain zaps” = electricity feeling in brain w/ headaches
What does the symptoms of SSRI withdrawal syndrome have an impact on?
- Participation in ADLs
- Communication & interpersonal relationships
- Learning & skills dvlp
- Recovery
- Balance & ROF
Define DA Precursors in the context of Parkinsonian medications.
DA Precursors, such as L-dopa and Duopa, cross the blood-brain barrier and can cause side effects like dyskinesia.
Which medications are used in parkinson disease?
- DA precursors
- DA adognist
- MAO B Inhibitors
- COMPT Inhibitors
- Anti-Acetylcholinergic
- Amantadine
How do DA Agonists differ from DA Precursors in Parkinsonian treatment?
DA Agonists have a longer half-life. Differents side effects
Explain the role of DA Precursors in the parkinson medication?
-> L-dopa, Duopa
- Crosses BBB (= Blood brain barrier) ⇒ converted into DA
- Side effect: dyskinesia
- Adaptation is reponsible for the necessity of re-adjusting the dosage
Explain the role of DA Agonist in the parkinson medication?
- Longer half-life but less effective as L-Dopa (DA precursors)
- Common side effects: hallucinations, sleepiness, compulsive behavior
Explain the role of MAO B Inhibitors in Parkinson’s treatment.
+ Side effects
- Prevents DA breakdown
- Caution with antidepressants → Life threatening
- L-dopa ⇒ Hallucinations increase prevalence
- Side effects : Nausea & insomnia
What is the function of COMT Inhibitors in Parkinsonian medications?
+ Side effect
- Prolongs L-dopa effects
- Risk of liver damage → rarely prescibred
What is the function of Anti-acetylcholinergic in Parkinsonian medications?
+ Side effects?
- Primary Use: used as an adjunct to L-Dopa therapy, helpful in regulating persistent dyskinetic symptoms
- Adverse effects : Memory deficit, Confusion, Hallucinations, Constipation, Impaired urination
What is the function of Amantdatine in Parkinsonian medications?
+ Side effects?
- Characteristics: : Short-symptom relief, Used in later stages of dopamine-related diseases
- Mechanism: Provides immediate symptom management
-
Adverse Effects:
- Cardiovascular dysfunction
- Hallucinations
- Potential withdrawal and dependency issues
What are the limitations of the medication Amantdatine ine parkinson patient?
- Cannot be sustained long-term
- Typically used as a last-resort treatment
How do enhancing substances impact neuroplasticity?
Enhancing substances, typically excitatory neurotransmitter mimics, are associated with BDNF/GDNF release but carry a risk of withdrawal and addiction.
What types of substances inhibit neuroplasticity and what are their effects?
Inhibiting substances include anticonvulsants, benzodiazepines, and barbiturates, which can lead to worse functional outcomes.
Discuss the importance of treatment timing in relation to medication effects.
Treatment timing is crucial for assessing medication effects, considering the sleep-wake cycle, medication interactions, and ensuring patient safety during activities.
What is the Stevens-Johnson syndrome?
= skin and mucous membranes that’s typically triggered by certain medications or infections. It’s considered a medical emergency and is essentially a severe form of allergic reaction
What is the main Diuretic medication used?
mannitol, common used fot TBI
What does the clinician should be aware/careful for when patient is under Anticonvulsants?
- Safety linked to balance due to viusual side effects.
- Use vision related adaptations due to side effect -> provide high-contrast visual cues, verbal guidance..)
- Adapt timing of intervention due to fatigue & possible insomnia
- Monitor cognitive fatigue
What does the clinician should be aware/careful for when patient is under Calcium channel blockers?
- Should be careful for gait exercises due to Blurred vision, Important Dyskinesia, somnolence, weakness and decreased HR
=> No unsupervised exercises - Assess sleep hygiene
- Modify time of session depending on fatigue and sleep hygiene of patient
- Careful in position change <=> Dizziness, blurred vision, loss of balance..
What are bendodiazepines?
GABAenergic substances, that bind activating, potentializing the synapse
Cite Bendodiazepines commun medications
- Alprazolam (Xanax)
- Lorazepam (Activan)
- Clonazepam (Klonopin)
What is the mechanism of action of Bendodiazepines?
- GABAergic substances
- Bind and activate GABA-A receptors
- Increase duration of chloride channel opening
- Potentiate inhibitory neural activity
What is the half-life variation of :
- Alprazolam (Xanax)
- Lorazepam (Activan)
- Clonazepam (Klonopin)
- Alprazolam: 6-12 hours
- Lorazepam: 10-20 hours
- Clonazepam: 18-50 hours
What is the use of Alprazolam (Xanax) and the side effects?
- Most frequently prescribed
- Treats anxiety disorders
- Short-term use recommended
- High addiction potential
Side Effects:
- Drowsiness
- Memory and attention deficits
- Headache
- Nausea
- Constipation
- Irritability
What is the use of Lorazepam (Ativan) and the side effects?
- Used for:
- Schizophrenia
- Bipolar disorder
- Depression
- Panic disorders
- Alcohol withdrawal
- Sleep support
Adverse Effects:
- Respiratory depression
- Seizures
- Addiction risk
- Cognitive decline
- Dyskinetic symptoms
- Potential stroke risk
What is the use of Clonazepam (Klonopin) and the side effects?
- GABA-energic
- Antiepileptic
- Treats dyskinetic and myoclonic seizures
- Panic disorder management
Side Effects:
- Muscle weakness
- Coordination loss
- Confusion
- Depression
- Memory deficits
- Swelling of the face & tongue (allergic reaction)
What medication is used in severe sleep disorders? and what categorie of medication is it?
Zolpidem
-> Nonbenzodiazepine sedative
What are the side effects of Zolpidem?
-
Common side effects:
- Bitter or metalic taste in mouth
- Dry mouth
- Headaches
- Vertigo
- Irregular HR
- Hiarrhoea
- Sleepiness
What are the adverse effects of Zolpidem?
- Adverse effects :
- Memory loss
- Hallucinations
- Loss of balance
- Delusion
- Dissociative disorders
- Depression
