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547 > Week 6 Neuro > Flashcards

Week 6 Neuro Flashcards

1
Q

Parkinson

cardinal features

A
  • bradykinesia
  • resting tremor suppressed by movement
  • lead pipe rigidity with passive movement
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2
Q

Parkinson

motor features

A
  • resting tremor
  • lead pipe rigidity
  • bradykinesia
  • postural instability
  • gait: shuffling
  • freezing (initiating, turns, obstacles)
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3
Q

Parkinson

non-motor features

A
  • autonomic dysfunction (bladder, bowels, postural instability)
  • dementia
  • depression
  • sensory (anosmia, paresthesia, pain)
  • sleep disturbance (nocturia, stiffness at night, RLS)
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4
Q

Treatment of anxiety in elderly

SSRIs and SNRIs recommended

  • which one is well tolerated?
  • common side effects?
  • increased risk in elderly?
A

escitalopram, citalopram
SERTRALINE

side effects: GI upset, insomnia, sexual dysfunction, sedation

INCREASE risk GIB if on concurrent NSAIDs
INCREASE risk bone density loss, hip fracture, SIADH

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5
Q

Treatment of anxiety in elderly

SNRI
-venlafaxine side effects

-duloxetine side effects:

A

venlafaxine: sexual dysfunction, sweating, increase in SBP and DBP

duloxetine: BP not as affected
monitor for urinary retention, sweating

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6
Q

Treatment of anxiety in elderly

TCA - why avoid?

MAOI - why avoid?

A

TCA: anticholinergic: orthostatic hypotension, falls, urinary retention, confusion, cardiac effects

MAOI: orthostatic hypotension, falls, HTN crisis

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7
Q

are benzos recommended for treatment of anxiety in elderly?

A

risks&raquo_space;»> benefits

recommend lorazepam, oxazepam or temazepam if MUST be used (metabolized by conjugation)

RISK of falls, hip fracture, cognitive impairment, dementia

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8
Q

treatment of anxiety in elderly

are antipyschotics recommended?

A

black box warning!

increased mortality esp in elderly with dementia

Quetiapine is effective for GAD

Risk long term use: increase osteopenia, bone loss

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9
Q

features of delirium

AIDA

A

AIDA

  • acute, fluctuating
  • inattention
  • disorganized thinking
  • altered LOC
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10
Q

what neurotransmitters are imbalanced in delirium?

A

cholinergic deficiency

dopaminergic excess

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11
Q

what drug class is implicated as precipitator and predisposing factor in delirium?

A

anticholinergics!

esp oxybutynin and diphenhydramine

**think of anticholinergic burden

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12
Q

for hospitalized patients, what are the common modifiable triggers for delirium?

A
  • fluid and electrolyte imbalance
  • infection
  • drug toxicity
  • metabolic d/o
  • sensory and environmental problems (eg untreated pain, missing hearing aids or glasses, poor sleep)
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13
Q

Dementia

MMSE ratings:
mild:
moderate:
severe:

A

mild: 20-26
moderate: 12-29
severe: <12

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14
Q

Death from severe dementia is often a result of what processes?

A

malnutrition

infections (aspiration pneumonia, pressure ulcers)

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15
Q

Pathophysiology of Alzheimer’s

A 
amyloid beta (ABeta) plaques and tau fibrillary tangles 
Plaques and tangles cause "downstream" effects: synaptic dysfunction, mitochondrial damage, vascular damage, and inflammation
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16
Q

Alzheimer’s non-modifiable risk factors

A
  • genetics
  • family hx
  • Down syndrome (APP gene carried on chromosome 21)
  • low education
  • CKD
  • afib
  • depression
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17
Q

Dementia modifiable risk factors

what class of meds?

A

HTN

  • CVD
  • obesity
  • DM
  • sedentary lifestyle
  • OSA
  • social isolation
  • ETOH, smoking
  • anticholinergic meds, benzo, PPI
  • environmental pollutants
  • brain trauma
  • hearing impairment
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18
Q

Workup of cognitive impairment

Labwork?

A

B12 level, TSH, HIV, syphilis, metabolic screen, liver enzyme, CBC, lytes

*identify reversible causes

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19
Q

Components of HISTORY differentiating between:

  • MCI
  • Alzheimer’s
A

MCI: cognitive deficits across one or more domains

Alzheimer’s progressive memory loss and other cognitive deficits
-impact on ADL and IADL

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20
Q

Components of HISTORY differentiating between:
Vascular dementia
Lewy Body dementia

A

vascular: hx vascular risk factors: eg hx of stroke/TIA
* executive function as prominent early symptom
* can commonly present WITH Alzheimer’s (Mixed dementia)

Lewy body:
-well formed visual hallucinations, REM sleep disorder, falls, fluctuating cognition

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21
Q

Dementia DDX

A
  • depression
  • OSA
  • NPH
  • subclinical seizures
  • SDH
  • untreated hearing and vision impairment
  • side effect of anticholinergic meds
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22
Q

Treatment of Dementia

A

NO disease modifying or curative drug therapies for MCI, AD or other dementia

goal is to improve QoL
support autonomy
Person-Centered Care Framework
Informed decision making and self-determination

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23
Q

side effects associated with cholinesterase inhibitors (donepezil, galantamine, rivastigmine)

A 
GI distress
wt loss
urinary urgency
BRADYCARDIA, syncope
sleep disturbances (vivid dreams)
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24
Q

side effects associated with NDMA receptor inhibitors (memantine)

A

Fewer s/e but can be dizzy, hallucinations, and increased agitation

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25
Q

what type of dementia should NOT be treated with cholinesterase inhibitors or NDMA receptor inhibitors?

A

frontal-temporal dementia (may worsen symptoms)

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26
Q

What is the DICE approach to BPSD ?

A

describe
investigate
create
evaluate

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27
Q

risk factors for late life depression?

A 
chronic medical illness
loss of loved one
relocation
disability
social isolation
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28
Q

older adults with depression are more likely to present with what symptoms?

A

may deny depression or mood symptoms

may have more physical/somatic symptoms
suspect depression if somatic complaints out of proportion to medical illness

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29
Q

how is depression differentiated from normal grief and bereavement?

A

grief does not impact functioning (or at least very minimal)

typically does not have active suicidal ideation or florid psychosis

grief generally recovers 1 year after loss

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30
Q

what co-morbidities have strong correlation with depression?

A 
stroke
arthritis
heart disease (MI and heart failure)
cancer
substance use
iatrogenic (meds: benzos, opiates, steroids)
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31
Q

symptoms of manic episode
(DIGFAST)

duration?

A

Distractibility
Impulsitivity / Indiscretion (excessive involvement in pleasurable activities
Grandiosity – Inflated self-esteem
Flight of ideas / Racing thoughts
Activity increase / Increase goal-directed behavior (socially, sexually, at work, etc)
Sleep deficit (decreased need for sleep)
Talkativeness (pressured speech)

distinct period of at least 7 days of persistently elevated, expansive, irritable behaviour
-at least 3 of following

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32
Q

depression screening

A

Geriatric Depression Scale
PHQ-9
Beck
suicidal ideation

**always test cognitive functioning
(MMSE, MoCA, mini-cog)

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33
Q

SSRI common side effects

A

GI upset

Diarrhea (sertraline)

constipation (paroxetine)

Insomnia, jitteriness

Hyponatremia

GIB

Extrapyramidal (tremors, parkinsons, bruxism)

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34
Q

SSRI prescribing precautions in elderly

A

CYP450 – watch drug interactions

*choose escitalopram, citalopram or sertraline (little effect on CYP450)

SIADH: risk factors age, female, low weight, use of diuretics, NSAIDs
*symptoms: fatigue, anorexia, confusion

GIB: risk factors use of NSAIDs, ASA, anticoagulants

Prolonged QT: citalopram, dose dependent

  • max dose 20 mg if age >65
  • max dose 40 mg up to age 65
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35
Q

Balance

3 main sensory inputs to maintain balance

A

Proprioception (muscle spindles, golgi tendon)

Vestibular: position and acceleration of head in space, CN VIII to vestibular nuclei

Vision

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36
Q

Screening for falls risk: 3 questions

A

Have you fallen in the last year?

Do you worry about falling?

Do you feel unsteady when standing or walking?

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37
Q

Symptoms often seen with falls?

A

syncope/presyncope
vision
cognition impairment
urinary urgency/impairment

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38
Q

Components of physical assessment for frequent falls

A

Cognition: MMSE, miniCOG MOCA
*even in absence of reported cognitive changes
CNS: neuro exam
*sensation in feet
CV: orthostatic hypotension
MSK: strength, resting muscle tone, tremors
Vision
Gait exam
Balance: tandem gait, Romberg
TUG (over 12 sec is positive for falls risk)
Get up from chair

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39
Q

Gait assessment: 4 S’s

A

Sit to stand
Speed (slow speed predicts falls, functional decline, death)
Stance (wide vs narrow)
Step (clearance, shuffling, symmetry, antalgic Trendelenberg)

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40
Q

Medication culprits linked to falls

A 
antidepressants
anticonvulsants
BENZOS***
sleep aids
anticholinergic meds
opiates
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41
Q

Dizziness is a broad term used to describe different sensations including:

A
  • vertigo (spinning)
  • disequilibrium (unsteadiness, only when erect, disappears when sitting/lying)
  • presyncope (lightheadedness, about to faint)
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42
Q

How is orthostatic hypotension defined?

A

SBP drop of 20+ mm Hg
DBP drop of 10+ mm HG
within 3 minutes of standing

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43
Q

How is postprandial hypotension defined?

A

SBP drop of 20+ mm Hg within 1-2 hours of eating

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44
Q

Acoustic neuroma

symptoms?

A

unilateral SNHL

  • high frequency
  • poor word recognition

Unilateral and rapid progression
Disequilibrium not related to position
Tinnitus

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45
Q

Nystagmus with peripheral lesions?

central lesions?

A

peripheral: unidirectional horizontal/rotational nystagmus
central: easily seen in light, vertical or gaze-evoked

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46
Q

Modifiable risk factors for stroke

Which one is most important?

A 
HTN ***most important**
DM
Hyperlipidemia
Afib
OSA
Smoking
ETOH (light to mod associated with DECREASED risk, heavy use associated with INCREASED risk)
Inactivity
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47
Q

Sequence of assessment for suspected stroke

A
  • initial survey (LOC, speech, following instructions, weakness)
  • gaze deviation, pupils, facial weakness, tone
  • VS and capillary glucose
  • imaging
  • NIHSS assessment
  • *only finger stick glucose is needed before starting IV alteplase
  • INR if on warfarin

Other labs can wait

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48
Q

timeframe for IV alteplase

A

Treatment window: within 3-4.5 hours

ideally before 3 hours

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49
Q

TIA

why is rapid recognition important?

A

symptoms usually last 15-20 min with complete recovery

TIA is a notable risk factor for subsequent stroke
**especially high in first 90 days after TIA

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50
Q

what is the single most important treatable risk factor for stroke?

A

BP control

goal of SBP <140, DBP <90

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51
Q

Secondary ischemic stroke prevention

A

ANTIPLATELET agent for all pts after first stroke
ASA (50-100 mg daily), clopidogrel (75 mg)
*depends on underlying etiology
*DAPT (dual antiplatelet therapy) if TIA and minor stroke
Duration should not be > 3 months

STATINS for hyperlipidemia

  • HIGH DOSE atorvastatin 80 mg daily
  • diet has NO effect on stroke incidence
  • shared decision making if limited life expectancy (<5 years)

ANTICOAGULATION for pts with afib

  • DOAC preferred over warfarin *consider renal function
  • ASA 325 mg if unable to take po anticoagulant
  • left atrial appendage (LAA) occlusion device eg Watchman if nonvalvular AF

SMOKING CESSATION

DIABETES glycemic control

PHYSICAL ACTIVITY

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52
Q

What is the most common underlying etiology of seizures in older adults?

A

STROKE

  • early seizures: within 2 weeks of stroke
  • late onset: >2 weeks after stroke

post-stroke seizures associated with poor functional recovery and outcomes

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53
Q

Complications seen in post-stroke survivors?

A 
falls
*hip fractures
dysphagia --> weight loss, apathy
fatigue
pain (1-3 months after stroke)
seizures
sleep disorders: OSA, central sleep apnea, cheyne-stokes breathing
depression
urinary and fecal incontinence
spasticity
cognitive impairment
54
Q

Idiopathic normal pressure hydrocephalus

Symptoms?

A

gait and balance impairment
cognitive impairment
urinary incontinence

insidious onset over 3 months

55
Q

Giant cell arteritis (temporal arteritis) is a type of _____ vessel arteritis

A

large vessel

*typically also involves medium and small arteries esp superficial temporal arteries

56
Q

Complications of untreated giant cell arteritis?

A

BLINDNESS
vision loss is often irreversible - abrupt and painless
CVA, MI, death, dissecting aortic aneurysm

57
Q

Risk factors for giant cell arteritis?

A

Age > 50 peak onset 70-80

F > M

Genetic (HLA-DR4 haplotype)

Infection

PMR (15% develop GCA, conversely, 50% people with GCA have PMR)

Northern European descent

Smoking

58
Q

Characteristics of headaches in giant cell arteritis?

A

New-onset or new pattern

Localized to temporal or occipital area

Characteristics: Throbbing, continuous, dull, boring, burning

Focal tenderness, scalp tenderness with combing hair

59
Q

Giant cell arteritis

symptoms?

A 
new onset headache (temporal or occipital)
blurred vision
diplopia
jaw claudication 
neck/shoulder/pelvic girdle pain
fatigue
fever
60
Q

Giant cell arteritis

most common cause of vision loss?

A

anterior ischemic optic neuropathy (AION)

  • pale edematous optic disc
  • edema resolves within 10 days
  • retinal artery occlusion –> diffuse retinal edema
61
Q

Features of polymyalgia rheumatica?

A

Aching and morning stiffness last >30 min, worse with exertion, may be severe

Neck, shoulder girdle, hip girdle

At least 1 month

Age 50+

62
Q

gold standard diagnostic test for temporal arteritis?

A

temporal artery biopsy

63
Q

Giant cell arteritis:

5 criteria for diagnosis

A

ESR > 50

(CRP often elevated, higher sensitivity and specificity than ESR)

Age > 50

New-onset HA

Temporal artery tenderness to palpate or decreased palpation

Abnormalities of artery on biopsy (multinucleated giant cells)

64
Q

Treatment of GCA

A

start on oral prednisone 40-60 mg/day
*temporal artery biopsy within 1 week
higher doses if visual or neurological symptoms
F/U within 72 hours

ASA 81 mg
PPI
Calcium and vit D

65
Q

Headache red flags SNOOP4

A 
systemic symptoms: fever, chills, myalgia, weight loss
Neurologic symptoms (focal)
Older age at onset (>50 years)
Onset: thunderclap (peak intensity 60 seconds)
P1: papilledema
P2: positional
P3: precipitated by Valsalva or exertion
P4: progressive headache, pattern change
66
Q

Headache red flags to suspect giant cell arteritis?

A
  • older age at onset
  • progressive
  • systemic symptoms
  • polymyalgia rheumatica
67
Q

Labwork for suspected giant cell arteritis?

A

ESR or CRP

CBC: normochromic anemia, thrombocytosis

68
Q

Characteristics of cardiac cephalgia headache?

A

headache triggered by exertion
relieved with rest
Relieved by nitro (in migraine, nitro will make migraines worse)

**diagnosis: stress test

69
Q

Characteristics of headaches from subacute glaucoma?

A

headache with duration <4 hours

visual blurring triggered by LOW LIGHT (causing mydriasis that increases IOP)

70
Q

Definition of medication overuse headache

A

headache occurring 15+ days per month with overuse of medication

Overuse: >10 or 15 days per month

71
Q

diagnostic evaluation of new onset headache in older adults?

A

neuroimaging: CT

CBC, CRP/ESR

72
Q

Symptoms of cluster headache

A

unilateral pain
severe, stabbing, short duration
orbit, temple, cheek

Tearing
ptosis
nasal congestion, rhinorrhea

73
Q

what does clock drawing test assess?

A

executive functioning

74
Q

what are modifiable causes of cognitive impairment?

A
  • delirium
  • depression
  • hyponatremia
  • thyroid d/o
  • hypercalcemia
  • B12 deficiency
  • ETOH
  • polypharmacy
  • comorbidities
75
Q

Diagnosis of dementia:

2 or more of the following cognitive domains:

A 
memory
language
visuospatial
executive function
behavior

causing significant FUNCTIONAL DECLINE in daily life activities/work

76
Q

core features of Lewy Body dementia

A

fluctuating cognition, variation in attention and alertness

  • recurrent visual hallucinations (well formed, detailed)
  • spontaneous motor features of Parkinsonism
  • REM sleep disorder

dementia occurs BEFORE or CONCURRENTLY with onset of Parkinsonism

77
Q

core features of frontotemporal dementia

A
  • early personality changes: apathy, disinhibition, executive function failure
  • decline in hygiene, mental rigidity, distractibility, perseveration
  • prominent language changes

relatively preserved memory, spatial skills, praxis

78
Q

PRISME: modifiable factors that can contribute to onset of delirium

A

P: pain, poor nutrition

R: retention, restraints

I: infection, illness, immobility

S: sleep, skin, sensory deficits (hearing, glasses)

M: mental status, meds, metabolic (abnormal labs)

E: environment (change)

79
Q

primary vs secondary vs tertiary prevention

A

Primary prevention: Prevent it from happening

Secondary intervention: Prevent recurrence

Tertiary: Managing consequences

80
Q

ETOH guidelines for older adults age 65+?

A

Adults age ≥65 years should not consume more than seven drinks in a week and should not consume more than three drinks on a given day

81
Q

Contraindications to outpatient ETOH withdrawal management?

A

PAWSS score >4
Severe or uncontrolled comorbidities (DM, COPD, heart disease)
-acute confusion/cognitive impairment
-acute illness/infection
-concurrent active MH suicidal ideation/psychosis
-concurrent severe drug use
-pregnancy
-hx of withdrawal seizure
-multiple failed attempts at outpatient withdrawal
-sign of liver compromise
-failure to respond to meds after 24-48 hours

  • inability to attend daily medical visits for first 3-5 days, alternating days after
  • inability to take po meds
  • no reliable family member who can monitor symptoms
  • any serious risk deemed by clinician’s best judgment
82
Q

symptoms of alcohol withdrawal

A 
tachycardia
pyrexia
tremor
nausea, vomiting
sweating
agitation, anxiety
insomnia
83
Q

what are the two options for pharm management of ETOH use disorder?

A

if goal is reduced drinking: naltrexone

if goal is abstinence: acamprosate or naltrexone

84
Q

Naltrexone for AUD

contraindications?

side effects?

A

contraindicated:

  • current opioid use (must be opioid free for 7-10 days)
  • acute opioid withdrawal
  • acute hepatitis/liver failure

side effects:
nausea, headache, dizziness

85
Q

Naltrexone for AUD

monitoring

A

LFT at start and 1, 3, 6 months

86
Q

Acamprosate for AUD

contraindications?

side effects?

A

contraindicated:
-severe renal impairment
-breastfeeding
CAUTION geriatric

side effects:
diarrhea, vomiting, abdo pain

87
Q

Acamprosate for AUD

monitoring

dosing

A

no safety risk with mild renal impairment, hepatic toxicity

moderate renal impairment: dose reduction

2x 333 mg TID

88
Q

Multivitamin supplementation in AUD

A

thiamine (100mg)

folic acid (1mg)

vitamin B6 (2mg)

89
Q

Max drinking limits

men
women

how often should screening occur?

A

men up to age 65:

  • 3 drinks or less in a day AND
  • 15 drinks or less in a week

healthy women AND healthy men over 65:

  • 2 drinks or less in a day AND
  • 10 drinks or less in a week

*annual screening

90
Q

Mallampati score

Class I
Class II
Class III
Class IV

A

Mallampati Score

Class I: soft palate, uvula, and tonsillar pillars are visible

Class II: Soft palate and Uvula are visible

Class III: Only Soft palate and base of the uvula are visible

Class IV: Only hard palate is visible

91
Q

STOP BANG for sleep apnea

A

The mnemonic STOP is helpful and includes the following:

S: “Do you snore loudly, loud enough to be heard through a closed door?”

T: “Do you feel tired or fatigued during the daytime almost every day?”

O: “Has anyone observed that you stop breathing during sleep?”

P: “Do you have a history of high blood pressure with or without treatment?”

ALSO»>The mnemonic BANG is also useful, as follows:

B: BMI greater than 35

A: Age older than 50 years

N: Neck circumference greater than 40 cm (16 in)

G: Gender, male

92
Q

signs and symptoms of obstructive sleep apnea? central sleep apnea?

A

both:

  • sleep deprivation, excess daytime fatigue
  • headache, difficulty concentrating
  • morning headache

CSA:
-nocturia, stress induced insomnia, nocturnal anigna chest pain

OSA:
-snoring, hypopnea, repeated arousals from sleep, decreased libido

93
Q

Insomnia diagnostic criteria

A

difficulty falling asleep, or waking up throughout the night or in the early-morning and then struggling to fall back asleep.

The second criteria is that the disturbance must be present for more than three times a week for at least three months.

The third criteria is that the sleep pattern must affect the individual’s life - like their performance at work or their relationships, and the symptoms shouldn’t be better explained by other sleep conditions.

94
Q

TIA

secondary ischemic stroke prevention:
BP control target?

A

Treat if SBP 140+

DBP 90+

95
Q

Bells palsy

affects which CN?

Symptoms?

A

CN VII
Common findings

Unilateral facial weakness w/ inability to close one eye

Sagging of one eyelid

Ipsilateral retroauricular pain w/ or preceding paralysis

Mouth drawn to affected side

Loss of nasolabial fold  
Hyperacusis or hypersensitivity to sound 
Dysgeusia or perversion of taste  
Facial paraesthesia 
Drooling  
Decreased tearing
96
Q

Bells palsy

first line pharm tx?

A

Prednisone: for all patients

60 to 80 mg po once a day x 1 week

Take with food in the morning

Monitor mood and sleep, may cause hyperglycemia if DM

valacyclovir: not to be used as monotherapy, only given in conjunction with steroid for severe cases

1000 mg three times daily for one week

for patients with severe facial palsy at presentation

97
Q

in older adults, headache is more common in strokes in _____ vs _____ circulation

A

-more common in POSTERIOR circulation

98
Q

secondary headaches in older adults:

Red flags for:

  • CVA
  • ICH
  • neoplasm
A

CVA: neuro deficits

ICH: thunderclap headache, neuro deficit, decreased LOC, anticoagulated

neoplasm:
-subacute neuro deficit, papilledema

99
Q

secondary headaches in older adults:

Red flags for:

  • cardiac cephalgia
  • sleep apnea
  • subacute glaucoma
A

cardiac cephalgia:
-precipitated by exertion, relieved by rest and nitro

sleep apnea: morning headache

subacute glaucoma: lasts <4 hours, with visual blurring, triggered by dim light

100
Q

medication overuse headache

definition of overuse?

other meds that cause headaches?

A

10-15 days/month

other meds:

  • nitro
  • nifedipine
  • dipyimadole
  • PPI
  • SSRI
101
Q

contraindications to triptan use?

A

hx of TIA, CVA, CAD

102
Q

trigeminal neuralgia

symptoms?
which cranial nerve involved?

A

electric shock along trigeminal nerve
CN V

V1 ophthalmic
V2 maxillary
V3 mandibular

**most often affects V2 and V3

Symptoms: unilateral severe electric shock facial pain

  • seconds to 2 min
  • 0-50x/day
  • does not wake up at night
103
Q

Trigeminal neuralgia

first line treatment?

A

carbemazepine (tegretol)

100-200 mg BID initially, slow titration until pain relief
treat for 6+ months

side effects: nausea, vomiting, diarrhea, hyponatremia, SJS/TEN

CYP and test for HLA-B*15:02 in Asians (high risk SJS/TEN)

104
Q

difference between MCI and dementia?

A

MCI: functional ability preserved

dementia: across multiple domains, interferes with ADLs

105
Q

MMSE cut off

mild dementia

mod dementia

severe dementia

A

mild: 20-26
mod: 12-19
severe: <12

106
Q

Lab workup for cognitive impairment?

A

CBC, lytes, B12, TSH, HIV, syphilis, LFTs

107
Q

lewy body dementia and parkinson dementia is associated with what symptoms?

what sleep disorder?

A

fluctuating cognition

well formed hallucinations

REM sleep disorder

108
Q

What is a prominent early symptom in vascular dementia?

A

executive dysfunction

109
Q

what portion of brain is affected in Alzheimers?

A

median temporal,
parietal, and/or
hippocampal atrophy

110
Q

what neurotransmitters are involved in patho of delirium?

A

cholinergic deficiency

dopamine excess

111
Q

Lewy body dementia

vs

Parkinson disease dementia

A

Parkinson Disease Dementia (PPD): if PD symptoms for 1 year before onset of dementia

Lewy Body Dementia (LBD): if onset of dementia precedes or at same time as onset of PD symptoms

112
Q

parkinson disease

patient counselling re: taking sinemet (levodopa/carbidopa)?

A

common side effect is nausea, vomiting, hypotension

nausea is due to inadequate carbidopa

Take on empty stomach (protein interferes with absorption)

113
Q

LDL target if atherosclerotic CVD (ASCVD)?

ie stable angina, MI, ACS
stroke, TIA
AAA
PAD

A

LDL <1.8

non-HDL <2.4

apoB <0.7

114
Q

what is the pre-screening question if someone has AUD and is interested in treatment?

A

has pt consumed alcohol in the last 30 days?

if yes—> do PAWSS

115
Q

Alcohol use disorder:

if PAWSS is <4, first line option for alcohol withdrawal management?

A

carbamazepine
gabapentin
clonidine

benzo is NOT preferred, prescribe fixed dose and short course (monitor frequently for relapse)

116
Q

common medications that cause dizziness?

A 
anticonvulsants
anxiolytics
antidepressants
NSAIDs
antiarrhythmics
diuretics
anti-HTN
antihistamines
117
Q

what is the quick 2 question screen for depressive disorders?

A
  • in the last month, have you been
  • bothered by little interest or pleasure in doing things
  • feeling down, depressed or hopeless
118
Q

risk factors for chronic depression?

A
  • early age onset
  • high number previous episodes
  • severity of initial episode
  • disruption in sleep/wake cycle
  • presence MH comorbidities
  • family hx MH
  • negative cognitions
  • highly neurotic
  • poor social support
  • stressful life
119
Q

what is the DSM criteria for dysthymia aka persistent depressive disorder?

A

Depressed mood for most of the day, for more days than not, for at least 2 years
Presence, while depressed, of ≥2 of the following:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness

During 2 year period, individual has never been without symptoms in A or B for more than 2 months at a time

120
Q

what are some non-modifiable risk factors for high risk suicide?

A 
Non-modifiable 
• Old age
• Male Gender
• Being widowed or divorced
• Previous attempt
• Losses (e.g., health, status, role, independence, significant relations)
  • family hx suicide
  • hx legal problems
  • sexual minority
121
Q

SADPERSONS for suicide risk

A

Sex (male)

Age <19 or >45

Depression or hopelessness

Previous suicide attempts of psychiatric hospitalization

Excessive alcohol or drug use

Rational thinking loss

Single, divorced or widowed

Organized serious attempt

No social support

Stated future intent

122
Q

first line psychological treatment for acute MDD?

A

CBT
**group therapy less effective than individual therapy but improves access

CBT as effective as antidepressant for MDD
combo CBT and rx more effective than either alone

123
Q

first line treatment for MDD

mild?
moderate to severe?

A

mild: psychoeducation, self management, counselling

consider pharm if pt preference, previous response to rx, lack of response to non-pharm

moderate to severe: start rx

124
Q

how often to reassess a patient after starting antidepressant?

A

within 2 weeks

  • *lack of early improvement at 2-4 weeks is predictor of later non-response or non-remission
  • *increase dose at 2-4 weeks if no improvement and tolerating s/e

f/u again every 2-4 weeks

review at 6-8 weeks
if well, continue on rx for 6-9 months

125
Q

3 examples of antidepressants that cause more sedation (helpful with agitation or insomnia)?

A

TCA
trazodone
mirtazapine

126
Q

what class of antidepressant is linked with SIADH and hyponatremia?

A

SSRI

127
Q

risks associated with ST John’s Wort

A

**CYP inducer

**MANY medication interactions including warfarin, oral contraceptives, SSRIs, digoxin, anticonvulsants. very long list

**risk of serotonin syndrome and hypomania with SSRIs and triptans

128
Q

how long do anxiety symptoms have to be present to meet DSM criteria for GAD?

A

6 or more months

129
Q

two questions screen for GAD?

A

over last two weeks, how often have you felt:

  • nervous/anxious/on edge
  • not able to stop/control worrying
130
Q

FINISH mnemonic for SSRI withdrawal syndrome

A 
flu
insomnia
nausea
imbalance
sensory change
hyper (agitation)

547 (11 decks)

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