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NUR1143 > Week 2 - Neuro + Headaches > Flashcards

Week 2 - Neuro + Headaches Flashcards

1
Q

Contraindications and Drug interactions for Triptans

A

CAD and pregnancy.
Interactions with ergot alkaloids, SSRIs, SNRIs, MAOIs

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2
Q

What are the 3 kinds of Neuroglia found in the central nervous system?

A

Microglia and Oligodendrocytes, Astrocytes (“tiny little astronaut” in your brain)

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3
Q

What are the 2 kinds of Neuroglia found in the peripheral nervous system ?

A

Satelite cells, Schwann cells

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4
Q

Afferent vs Efferent neurons do what?

A

Afferent: Carry impulses from peripheral receptors to CNS

Efferent: Transfer from CNS to gland, organ, muscle

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5
Q

In a neuron, what is the functional difference between Dendrites and axons?

A

Dendrites carry nerve impulse towards the cell body, Axons carry nerve impulse away from the cell body

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6
Q

Myelin sheath is created by neuroglia. What cells compose the myelin sheath in the central,vs peripheral nervous system?

A

central: oligodendrocytes

Peripheral: schwann cells.

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7
Q

Describe the three types of neuron: Sensory,
Interneuron,
Motor

A

Sensory: (afferent)
Carry impulses from peripheral receptors to CNS

Interneuron: (associational)
Only in CNS

Motor: (efferent)
Transfer from CNS to gland, organ, muscle

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8
Q

Three main structural divisions of the brain

A

Forebrain, midbrain, hindbrain

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9
Q

The forebrain contains the cerebrum, name the cerebrum’s Four Lobes:

A

Frontal, Parietal, Temporal, Occipital

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10
Q

3 components of the brainstem

A

Midbrain, Pons, Medulla

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11
Q

What is the RETICULAR FORMATION (or “reticular activating system”):

A

large collection of diffuse nuclei found throughout the brain. Connects cerebral cortex to brain stem. Controls vital reflexes like CV function and breathing, maintaining wakefulness.

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12
Q

What is the BASAL GANGLIA

A

group of structures deep within Cerebral hemisphere and brainstem, primarily involved in controlling VOLUNTARY MOVEMENTS, as well as learning, thinking, eye movements and emotion. (a gang where we eat basil, organize, learn, think, move our eyes and get emotional. )

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13
Q

What is the LYMBIC SYSTEM:

A

group of interconnected structures: amygdala, hypthalamus, hippocampus. emption, arousal, long term memory.

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14
Q

What is the Monroe-Kellie Doctrine?

A

The relationship between the 3 components of the cranium. The sum of the volumes of brain tissue, blood and CSF is constant. An increase in one component will cause a decrease in one or both of the other two components.

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15
Q

Indicators of Increased ICP

A

Change in level of consciousness

Headache

Projectile vomiting WITHOUT NAUSEA

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16
Q

Definition of episodic vs chronic headache

A

Episodic: less than 15 days/month

Chronic: at least 15 days/month, for at least 3 months

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17
Q

Meds for Tension-Type headache prophylaxis: -

A
  • Venlafaxine (effexor, an SNRI)*
    Mirtazapine *)
    Tricyclic antidepressants (amitriptyline, nortriptyline,

*caution in those under 18)

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18
Q

Migraine is defined as At least 5 attacks of a headache lasting 4-72 hours, with at least 2 of the following 4 characteristics: - Unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance of routine physical activity
PLUS one of what TWO symptoms???

A

PLUS Nausea and/or vomiting
OR Photophobia and phonophobia

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19
Q

four phases of Migraine headache

A
  • Premonitory phase
  • Migraine aura
  • Headache phase
    Recovery (postdrome) phase
20
Q

Neurovascular disorder that involves dilation and inflammation of the intracranial blood vessels. What sensory nerve and compounds are most involved?

A

Trigeminovascular system includes the trigeminal nerve and the projections of this nerve to surrounding intracranial blood vessels.
Also
Serotonin suppresses migraines
Calcitonin gene-related peptide (CGRP) promotes migraine

21
Q

MOA of Triptans

A

constricting intracranial blood vessels and reducing inflammation (by suppressing release of inflammatory neuropeptides, including calcitonin gene-related peptide)

22
Q

C/I of Triptans

A
  • Ischemic heart disease, prior MI, or uncontrolled hypertension. avoid in patients w/risk factors for CAD
  • SSRIs, SNRIs (risk of serotonin syndrome)
  • MAOIs (toxicity can result)
  • DO not give within 24h of another triptan (vasospasm)
  • C/I in pregnancy
23
Q

Triptans available for kids?

A

Only approved triptan 12-17y is Almotriptan (Axert)

None avail <12y

24
Q

S/E and C/I of Ergot Alkaloids

A

SE: n&v
Weakness in the legs, myalgia, numbness and tingling in the fingers and toes, angina-like pain, and tachycardia or bradycardia.

-hepatic or renal impairment
- sepsis (gangrene has resulted)
- CAD, peripheral vascular disease, and uncontrolled HTN
- taking potent inhibitors of CYP3A4 (can raise ergotamine to toxic levels)
- within 24 h of another triptan.
-C/I in pregnancy

25
Q

CYP3A4 inhibitors that can increase the liklihood of peripheral vasoconstriction when taking Ergot Alkaloids

A

MACROLIDES!!
Protease inhibitors, Verapamil (a CCB used in cluster headaches)

26
Q

Indications for preventive migraine therapy

A

3 or more attacks per month
Attacks that are especially severe,
Attacks that do not respond adequately to abortive medications

27
Q

First line for Migraine Prophylaxis

A

ß- blocking agents (Propranolol, metoprolol)

Antiepileptics: Divalproex (Depakote ER) (used most often)
Gabapentin
Topiramate

28
Q

Second line for Migraine prophylaxis

A

Tricyclic antidepressants, Estrogens, Localized injections (botox, anesthetic nerve blocks), CGRP receptor Antagonists.

29
Q

In cluster headaches, Lacrimation and rhinorrhea can be explained because of trigeminal nerve extending into which three branches?

A

Maxillary, Mandibular and Opthalmic zones

30
Q

How do Cluster headaches differ from Migraine headaches?

A

No aura
No nausea/vomiting
Generally more debilitating, unilateral
Not associated with a family history

31
Q

First and second line prophylaxis for Cluster headaches

A

1: Calcium Channel Blockers (Verapamil)
2) Neurostabilizers (lithium)

32
Q

Neuropathic pain: pain is caused by damage or injury to nerves
Pain may be described as shooting, cutting, electrical-like, tingling, or like pins and needles. What can cause this?

A

diabetic neuropathic pain, neuropathies with cancer or chemo, post herpetic neuralgia, and spinal cord injury

33
Q

Define Paresthesia
and
Dysthesia

A

Paresthesia
any abnormal sensations: burning, tingling, aching, cold sensation, lancinating, numbness, etc.
Dysthesia
painful paresthesia

34
Q

Define:
Allodynia
and
Hyperalgesia

A

Allodynia
Pain caused by non-painful stimuli (ie. blanket)
Hyperalgesia
Increased pain from a painful stimuli

35
Q

3 parts of the nervous system are responsible for sensation, perception and response to pain. Describe each stage.

A

1) Sensation – the afferent pathways of the peripheral nervous system carry information about pain to the dorsal horns of the spinal cord, where it then travels to the brain
2)Perception: Brainstem, midbrain, cerebral cortex and diancephalon (which includes thalamus, epithalamus, subthalamus) which leads to the response.
3) Response – information from the brain travels to the spinal cord for the body to respond

36
Q

There are 4 phases of nociception (processing of pain stimuli), what are they?

A

Transduction
Transmission
Perception
Modulation

37
Q

Transduction begins when the nociceptors perceive a painful stimulus.
There are 2 main types of nociceptors: Aδ (delta) and C fibers, how are they different?

A

The Aδ fibres are larger myelinated fibers that transmit sharp, well-localized painful sensations, and cause a spinal reflex reaction
The C fibers are smaller and unmyelinated. They transmit dull, aching or burning sensations that may be poorly localized and usually constant

38
Q

MOA of Tramadol

A

Weak agonist activity at the µ receptors
Blocks uptake of norepinephrine & serotonin which is thought to play a role in inhibiting pain

39
Q

S/E and medication interations to avoid with tramadol

A

Side effect of seizures

Avoid with MAO inhibitors, tricyclic antidepressants and SSRIs

40
Q

ADVERSE EFFECTS OF OPIOID AGONISTS

A

Constipation
Urinary retention
Orthostatic hypotension
Pruritus
Nausea and vomiting
Confusion
Sedation
Respiratory Depression
Addiction

41
Q

Opioid Agonist-Antagonists

A

Pentazocine (Talwin)
Nalbuphine (Nubain)
Buprenorphine

42
Q

A/E of Buprenorphine

A

Long QT syndrome

43
Q

Adjuvants or co analgesics often include what class of medications?

A

Antidepressants, anti convulsants, SSRI’s, SNRI’s, GABApentin, pregabalin

44
Q

First line for neuropathic pain

A

Tricyclic antidepressants, SSRI’s/SNRI’s, GABApentin and pregabalin

45
Q

Side effects of tricyclic antidepressant

A

drowsiness, confusion, dry mouth, dry eyes, urinary retention, constipation, prolonged QT interval

NUR1143 (6 decks)

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