Pharmacotherapy of Acute Neuronal Injury Flashcards
What is the most flexible portion of the spine and has the most injury
Cervical spinal cord
What nerves are associated with certain parts of the spine
Cervical: movement of the neck, diaphragm (breathing), arms and hands, heart rate
Thrombacic: muscles of breathing
Lumbar: movement of legs and feet
Sacral: bowel/bladder, sexual function
What are the goals of therapy
Stabilize the ABC’s, preserve neurological function, prevent medical complications
What are complications associated high spinal injury, what is the onset and duration of these compliacations
Hypotension and bradycardia, onset: two days and duration of 1 to 3 weeks
What is the goal MAP for patients with neurogenic shock, how is it treated
MAP greater than 85 for first 7 days after injury, fluids and vasopressors
What is the vasopressors best used in neurogenic shock
Norepinephrine and phenylephrine
When giving a neurologic evaluation what functions are tested and how
Motor function: respiration and muscle strength
Sensory function: proprioception and light touch pinprick
T/F: If a patient has a motor score of 0 they have no paralysis
False: If a patient has a motor score of 0 there is FULL PARALYSIS
What is tetraplegia, paraplegia, paresis, complete, incomplete
Paralysis of all four extremities, lower extremity paralysis, weakness, no motor or sensory function, retention of any motor or sensory function
T/F: In the ASIA impairment scale A is a complete loss of motor and sensory function in the S4/5 region while E no motor or sensory loss
True
What is the pathophysiology of neuronal injury
Transection, contusion/compression/stretch
What is the secondary injury
Induced depolarization, release of neurotransmitter, mitochondrial dysfunction, lipid peroxidation
What are the treatment option
Surgery, pharmacological, hypothermia (cooling the patient)
What are the benefits of methylprednisolone
Stabilizes membranes, decreases edema, increases spinal cord blood flow, scavenges free radicals, limity inflammatory response after trauma
When should methylpredinisolone be given for benefit
Within 8 hours of injury for improvement in motor and senosry scores at six months
What are adverse effects with using methylprednisolone
Wound infection and GI bleeding
What is the risks of giving methylprednisolone for longer infusions (48 hours)
Increased risk of sepsis and penumonia
If a patient does receive methylprednisolone for injury what is the dose
methylprenisolone 30 mg/kg IV bolus then 5.4 mg/kg/hour as an infusion for 24 hours if within 3 hours of injury
What are complications of methylprednisolone
Hyperglycemia, ulcer formation, impaired wound healing, immunosuprresion/infection, negative nitrogen balance
What are complication of Acute Spinal Cord injury
DVT, infection, pressure ulcers, heterotopic ossification, spasticity, autonomic dysreflexia
What is the third leading cause of death for ASC patients, risk factors
DVT/ Age, paraplegia vs tertraplegia, complete vs incomplete, lower extremity fractures, cancer, delayed thromboprophylaxis
What are the thromboprophylaxis in ASCI, duration
Intermittent pneumatic compression PLUS Low dose unfractionated heparin OR intermittent pneumatic compression PLUS low molecular weight heparin, vena cava filters for those who can’t recieve coagulation/ up to three months from the incident
What infections are most associated with infections
Urinary traction infections, pressure ulcers, pneumonia
T/F: Patients should get prophylaxis for infections for ASC
False: No role for prophylatic antibiotics when a patient has an ASCI
Where would injury to a spinal cord need to be in order to increase a risk for pneumonia, prevention
Injury above T4/ postural drainage,suctioning, yearly physical fitness test
What is the cause of heterotopic ossification, how long to develop, prevention, treatment
Deposition of bone in hips/knees, 12-16 months, motion exercises or indomethacin, NSAIDs and disodium etidronate
How is spsticity treated
Baclofen, diazepam, dantrolene
Injury to what part of the spinal cord causes autonomic dysreflexia , what are the symptoms
Injury above T6/ hypertension, headache/nasal congestion, bradycardia, sweating above lesion
What causes autonomic dysreflexia
Starts with noxious stimuli below the lesion causing the body to vasoconstrict due to no communication and further leads to the brain slowing the heart rate to compensate for the vasoconstriction
