Pharmacotherapy of Acute Neuronal Injury

Question 1

What is the most flexible portion of the spine and has the most injury

Answer 1

Cervical spinal cord

Question 2

What nerves are associated with certain parts of the spine

Answer 2

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

Question 3

What are the goals of therapy

Answer 3

Stabilize the ABC’s, preserve neurological function, prevent medical complications

Question 4

What are complications associated high spinal injury, what is the onset and duration of these compliacations

Answer 4

Hypotension and bradycardia, onset: two days and duration of 1 to 3 weeks

Question 5

What is the goal MAP for patients with neurogenic shock, how is it treated

Answer 5

MAP greater than 85 for first 7 days after injury, fluids and vasopressors

Question 6

What is the vasopressors best used in neurogenic shock

Answer 6

Norepinephrine and phenylephrine

Question 7

When giving a neurologic evaluation what functions are tested and how

Answer 7

Motor function: respiration and muscle strength

Sensory function: proprioception and light touch pinprick

Question 8

T/F: If a patient has a motor score of 0 they have no paralysis

Answer 8

False: If a patient has a motor score of 0 there is FULL PARALYSIS

Question 9

What is tetraplegia, paraplegia, paresis, complete, incomplete

Answer 9

Paralysis of all four extremities, lower extremity paralysis, weakness, no motor or sensory function, retention of any motor or sensory function

Question 10

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

Answer 10

True

Question 11

What is the pathophysiology of neuronal injury

Answer 11

Transection, contusion/compression/stretch

Question 12

What is the secondary injury

Answer 12

Induced depolarization, release of neurotransmitter, mitochondrial dysfunction, lipid peroxidation

Question 13

What are the treatment option

Answer 13

Surgery, pharmacological, hypothermia (cooling the patient)

Question 14

What are the benefits of methylprednisolone

Answer 14

Stabilizes membranes, decreases edema, increases spinal cord blood flow, scavenges free radicals, limity inflammatory response after trauma

Question 15

When should methylpredinisolone be given for benefit

Answer 15

Within 8 hours of injury for improvement in motor and senosry scores at six months

Question 16

What are adverse effects with using methylprednisolone

Answer 16

Wound infection and GI bleeding

Question 17

What is the risks of giving methylprednisolone for longer infusions (48 hours)

Answer 17

Increased risk of sepsis and penumonia

Question 18

If a patient does receive methylprednisolone for injury what is the dose

Answer 18

methylprenisolone 30 mg/kg IV bolus then 5.4 mg/kg/hour as an infusion for 24 hours if within 3 hours of injury

Question 19

What are complications of methylprednisolone

Answer 19

Hyperglycemia, ulcer formation, impaired wound healing, immunosuprresion/infection, negative nitrogen balance

Question 20

What are complication of Acute Spinal Cord injury

Answer 20

DVT, infection, pressure ulcers, heterotopic ossification, spasticity, autonomic dysreflexia

Question 21

What is the third leading cause of death for ASC patients, risk factors

Answer 21

DVT/ Age, paraplegia vs tertraplegia, complete vs incomplete, lower extremity fractures, cancer, delayed thromboprophylaxis

Question 22

What are the thromboprophylaxis in ASCI, duration

Answer 22

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

Question 23

What infections are most associated with infections

Answer 23

Urinary traction infections, pressure ulcers, pneumonia

Question 24

T/F: Patients should get prophylaxis for infections for ASC

Answer 24

False: No role for prophylatic antibiotics when a patient has an ASCI

Question 25

Where would injury to a spinal cord need to be in order to increase a risk for pneumonia, prevention

Answer 25

Injury above T4/ postural drainage,suctioning, yearly physical fitness test

Question 26

What is the cause of heterotopic ossification, how long to develop, prevention, treatment

Answer 26

Deposition of bone in hips/knees, 12-16 months, motion exercises or indomethacin, NSAIDs and disodium etidronate

Question 27

How is spsticity treated

Answer 27

Baclofen, diazepam, dantrolene

Question 28

Injury to what part of the spinal cord causes autonomic dysreflexia , what are the symptoms

Answer 28

Injury above T6/ hypertension, headache/nasal congestion, bradycardia, sweating above lesion

Question 29

What causes autonomic dysreflexia

Answer 29

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