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MS2 Unit3 Neurology > Week4 Lectures > Flashcards

Week4 Lectures Flashcards

1
Q

high blood pressure + tremors WITH seizures + delirium is chr of ___ withdrawal (etOH, cocaine, heroine)

A

etOH

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2
Q

VOLES is used to dx? what does it stand for

A

metabolic(non strutural) cause for acute confusion + agitation (

Vitamin defc 
O2/CO2 hypoxia/hypercabia (pneumonia)
Liver dmg 
Electrolyte ∆ (dehydration/Kidney)
Substances
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3
Q

altered mental status + hallucination; seizures* + , tremors* + psychomotor agitation; 2-5 days after last drink, lasting 1-5 days; death by arrhythmia (hypovolemia + ∆ electrolytes)

A

Delirium Tremens from etOH withdrawal

hint: ↑HR, BP, temp + diaphoresis

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4
Q

how do you tx delirium tremens?

A

tw benzos EARLY; AVOID SGAs only* (grand mal seizures kills pt)

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5
Q

on imaging: lesions in medial thalamus and hypothalamus; atrophy of mamillary bodies; confabulation dt affected fornix + hippocampus (short term recall)

A

Wernicke-Korsakoff dz

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6
Q

pt presents with confusion + cogn deficits; lateral and conjugate gaze palsy/paralysis; and ataxia

A

classic triad for Wernicke Encephalopathy

(encephalopathy; ophthalmoplegia; ataxia)

Cain criteria: 2/4 (defc risk + triad)

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7
Q

in WK rx, Low does thiamine is for ___ and high dose thiamine is for _____

A

prevention; treatment

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8
Q

Naltrexone, and Acamprosate; and Disulfiram are used to treat?

A

relapse prevention in etOH use do

hint: Disulfiram is 2nd line

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9
Q

Out of the 3 below, which is a Mu antag; GABA/glutamate modulator; ALDH blocker

Acamprosate/Naltrexone/Disulfiram

A

Mu Opiate antag = Naltrexone
Acamprosate = GABA/glu modulator
Disulfiram = ALDH blocker

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10
Q

3 methods to treating benzo dependence

A
  1. sub a short acting BZ with long acting BZ (clonazepam), then taper
  2. Phenobarb (less safe)
  3. anticonvulsants (Valproate + Carbamazepine?
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11
Q

how would you treat pt who is unresponseive, w/ miosis + resp depression?

A

heroin/opioid OD! tw Naloxone

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12
Q

pt with SNS arousal sx, GI distress; and flu-like sx (shivers, goosebumps, lacrimation + rhinorrhea) is most likely experiencing? (cocaine/etoH/opioid) ___ withdrawal

A

Opioid withdrawal

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13
Q

how to treat Acute opioid withdrawal,
mild?
moderate?
severe?

A 
mild = clonidine
moderate = buprenorphine (partial agonist)
severe = methadone
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14
Q

how to treat chronic opioid dependence:
opiate agonist?
partial opiate agonist?
opiate antagonist?

A
  1. opiate agonist = methadone maint.
  2. partial opiate agonist = Suboxone (buprenorphine + naloxone)
  3. opiate antagonist = Naltrexone (oral/IM)
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15
Q

sort the following efx among the 3 opiate rcps: euphoria, analgesia, dysphoria

A 
Mu =  euphoria + analgesia 
Kappa = dysphoria + analgesia 
Delta = analgesia ONLY
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16
Q

Top 3 illicit dugs used in order

A
  1. Marijuana
  2. Rx pain relievers
  3. Cocaine
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17
Q

Why is urine toxicology screen preferable?

A

drugs + metabs last longer in urine

hint: 72 hr (amphetamines, cocaine, opioids) 1wk-1mo (THC)

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18
Q

other useful tests for etOH screening (besides triglycerides + uric acid)

A

AST>ALT, inc MCV (>100)l CDT transferrin

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19
Q

Tox screens are avail for (4)

A

opioids
etOH
benzos
tobacco

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20
Q

DARES is used for ____; what does it stand for?

A

Motivational Interviewing Principles;

Develop discrepancy
Avoid Argumentation 
Roll with Resistance
Express Empathy by reflecting
Support Self-Efficacy
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21
Q

OARS is used for ____; what does it stand for?

A

Motivational Interviewing skills;

Open ended questions
Affirmation
Reflections
Summaries

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22
Q

Contraindication for Immunotherapy (Abs) for substance use do tx?

A

heart attack risk with over use

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23
Q

how is Amphetamine worse than Cocaine?

A

displaces DA from DAt and VMAT –> ↑DA gradient –> forcing DA into synapse via DAT (uncontrollable leaks) –> psychosis, agitation, aggressiveness

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24
Q

euphoria, hyperactivity, initial hypersexuality, anorexia; rigidity, seizures are chr in stimulant (withdrawal/intoxication)

A

intoxication

hint: confusion is rare

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25
Q

apathy, irritability, craving, depression, fatigue, hypersomnia/phagia lasting <72 h are chr in stimulant (withdrawal/intoxication)

A

withdrawal

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26
Q

peristent psychocosis and hallucinogen persisting perception disorder are are ____

A

long term effects of hallucinogens

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27
Q

Varenicline (Chantix) is used for ____; SEs in addition to nausea, insomnia, and nightmares include (3)

A

seizure
alcohol
CVD + MI

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28
Q

nicotine gum is contraindicated in

A

TMJ and dental dz

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29
Q

Bupropion (zyban) is used for ____; SEs in addition to depression, htn, arrthmia include (3)

A

SI**, seizure, eating disorder

30
Q

The nicotine patch is dosed for 1 mon each at __ ___ and ___; in addition to HS rxn, palipations, and dreams , SEs include (3)

A

21, 14, 7, mg/d

arrhythmia, post MI, pregnancy

31
Q

Off label smoking cessation drug that can cause SI arrhythmia, seizure, TD

A

Nortrptyline

32
Q

off label smoking cessation drug with post partum, perioperative warnings

A

clonidine

hint: SEs incl sedatio, brady, dry mouth, hypotn

33
Q

____ is the #1 cause in the preventable death

A

smoking

hint: 1 in 5 deaths

34
Q

___ is the most effective pharmatx for smoking cessation

A

varenicline

35
Q

5 A’s and 5 R’s for motivational interviewing

A 
Ask about use
Advise to quit
Assess willingness
Assist quitting 
Arrange f/u 1 wk after 
Relevance (stakeholders, prior attempts) 
Risk
Rewards
Roadblocks
Repetition
36
Q

inability to recall important autobiographical information *** dt traumatic/stressful event;

how is it different from dementia amnesia?

A

dissociative amnesia

dementia amnesia - forget recent events, date, time

hint: 5-20% combat amnesia

37
Q

bewildered wandering or purposeful travel assc w/ amnesia (identity/autobiographical info)

A

fugue state (dssc amnesia)

38
Q

name the type of memory:

  1. specific events and context
  2. words and meanings (objects, factos, concepts)
  3. how to perform actions; skills
A
  1. episodic
  2. semantic
  3. procedural
39
Q

name the type of memory:

  1. episodic + semantic
  2. muscle memory for tasks

xtra: brain structure responsible

A
  1. Declarative/Explicit - hippocampus

2. procedural/Implicit - Basal Ganglia

40
Q

presence of 2+ distinct personality traits that causes sgf distress or impairment; caused by dirupted attachment (↑stress from abuse, painful medical procedure)

A

Dssc identity do

hingt: sx begin in childhood

41
Q

fluctuations in skills/habits/knowledge; unexplained possessions; sudden changes in relationships

A

DID

42
Q

feelings of unreality/detachments from one’s self
being an outside observer

emotional/physical numbing

A

Depersonalization

43
Q

experiences of unreality/detachment from surroudnings

A

Derealization

44
Q

Onset of depersonzn/derealzn do is typically ____ and unusual for ____

A

adolescence or 20;

unusual in later adulthood

45
Q
  1. robust evidence for treating depression, anxiety, stress tolerance
  2. preliminary evidence for brain changes in just weeks
  3. emphasizes acceptance (non interfering obsv) in dealing with ±affect phobia
A

benefits of mindfulness meditation (3)

46
Q

works via:
placebo response
physio benefits/SEs of supplements
mind-body cxn

A

how CAM works

47
Q

Explain the cholinergic anti-inflamm pathway (2)

A
  • WBCs w/ ACh rcps inhib cytokine release
  • PNS (vagal input) inh inflamm

hint: mindful meditn - ↑PNS

48
Q

This can serves as monotx (mild) or adjunct (severe);

MOA includes:
↑5HT, NE
Mods HPA axis 
↑neural growth factors 
↑hippocampal neurogenesis
A

Exercise (Naturopathy)

49
Q

Kava kava and St Johns wort affect ___ and ____ respectively

A 
KK = liver damage; 
SJW = p450 interaction
50
Q

Sympathomimetic mydriatics (3)

A

pupillary dilators
Cocaine
Amphetamines
Methylphenidate (ADD)

51
Q

Anticholinergics mydriatics AAAS (4)

A 
pupillary dilators (block CN III) 
Antihistamines 
Antidepressants
Anticholinergics 
Sympathomimetics
52
Q

hallucinogens + alcohols are egs of (mydriatics/mitotics)

A

mydriatics

53
Q

opioids
sedative hypnotics
cholinergics (insecticides)
PCP (phenycyclidine)

are all egs of (mydriatics/mitotics)

A

miotics

54
Q

Sympatholytic miotics (2)

A

𝛂 blockade

  1. Clonidine (sedative anti-htn)
  2. tetrahydrazoline (eye drops)
55
Q

cocaine in the pediatric popn is explained by (3)

A
  1. placental transfer
  2. breast milk
  3. passive exposure to 2˚sources
56
Q

pediatric pt who is tachycardic, hypertensive, seizures, dilated pupils*, fever, diaphoresis. But labs, CSF, CT are all normal

A

cocaine intoxication

⊕urine tox screen

57
Q

10 yr pt recovering from chicken pox presents with sgf agitation suprapubic mass; absent bowel sounds, mydriasis, dry mucus membranes; temp, HR, RR, and BP are all ↑

large amt of versed was used to sedate

tx?

A

antihistamine OD –> toxic encephalopathy

tw Physostigmine (antilirium)

hint: looks like anticholinergic poisoning

58
Q

Name the drug class? Migraine tx that is selective 5HT 1B and 1D AGONISTS; 1st line for specific for migraines.

Action of each rcp type?

A

Triptans

1B = vasoC
1D = 1st/2nd order neuronal inh

hint: take early; ±prevent CGRP release

59
Q

What drug? migraine tx that acts via vasoC and ↓trigeminovasc pathway

A

ergotamines

hint: w/ caffeine

60
Q

longer acting migraine drug that can be used at later stage of attack; more SEs than triptain; pre rx with anti emetics in pregnancy (contra) ; IV use for status migrainous

A

DHE

61
Q

what SSNOOP used for and what does it stand for?

A

2˚headache red flags

Systemic sx
Secondary causes 
Neuro Signs 
Onset
Older age 
Pattern, Pregnancy, Papilledema
62
Q
  1. Triptans + DHE
  2. NSAIDS, cambia PWD, Ketoralac
  3. antiemetics ±benedryl

…in that order are all indicated for?

A

acute migraine treatment

63
Q
  1. Onabot
  2. Topiramate
  3. Propanolol/Timolol
  4. Amitriptyline

…in that order all indicated for? Which is FDA approved?

A

preventative migraine tx;

Onabot (botoxA) is the only FDA approved

64
Q

Name the number of days to classify MOH for each drug below:

  1. Triptans, ergots, DHE
  2. simple analgesics
  3. Butalbital
  4. Opioids
A
  1. > 10 days/mo
  2. > 15 days/mo
  3. > 5 days/mo
  4. > 8 days/mo
65
Q

Preferred preventative tx for TTH

A

amiTriptyline

hint: also NSAIDS, tylenol, muscle relaxants for acute

66
Q

4 S’s and ipsi ANS sx are indicative of? what do the 4 S’s stand for

A

TACS (trigem autonomic cephaglias);

Sidelocked
Severe
Short
Sharp

67
Q

Tx for SUNA and SUNCT TACS (1)

A

lamictal

68
Q

Tx for PH and hemicrania continua?

A

indomethacin

69
Q

cluster HA
SUNA + SUNCT
Paroxysmal hemicrania
Hemicrania continua

…these conditions are classf’d as?

A

TACS (trigem autonomic cephaglias)

70
Q
  1. 100% O2
  2. Sumatriptan
  3. Zolmitriptan (nasal*)
  4. IP/IV DHE
  5. Intranasal licocaine

…in that order all indicated for?

A

Abortive TACS tx

hint: also use nasal DHE; neuroleptic sedation

71
Q
  1. Prednisone taper (2 days)
  2. IV DHE (2-3 days)

…in that order all indicated for?

A

Transitional TACS Tx

hint: short term bridge tx

72
Q
  1. Verapamil (watch EKG)
  2. low dose lithium carbonate
  3. SPG block, topiramate, valp. acid, gabapentine, melatonin

…in that order all indicated for?

…in that order all indicated for?

A

preventative TACS tx (bridge)

MS2 Unit3 Neurology (10 decks)

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