308 - Central Nervous System and Anaesthesia Flashcards
(129 cards)
1
Q
At what age might people start showing symptoms of Parkinson’s?
A
Symptoms usually appear in people over 50.
2
Q
What does Parkinson’s affect?
A
Parkinson’s disease affects the way the brain coordinates body movements, including:
- walking
- talking
- writing
3
Q
If Parkinson’s disease occurs between the ages of 21 & 40 what is it called?
A
Parkinson’s disease, if it occurs between the ages of 21 & 40 is known as ‘young-onset’ Parkinson’s disease.
4
Q
Define Bradykinesia
A
Bradykinesia is slowness of movement, movements can become difficult to initiate, take longer to perform and lack co-ordination.
5
Q
What are the symptoms of Parkinson’s disease?
A
- bradykinesia
- tremor (shaking)
- muscular rigidity or stiffness
- tiredness
- constipation
- bladder weakness
- depression
- problems associated with handwriting, speech & balance
- difficulty swallowing
6
Q
Parkinson’s disease is caused by a loss of nerve cells in which part of the brain?
A
Parkinson’s disease results from the loss of nerve cells in a part of the brain called the substantia nigra.
7
Q
What are the nerve cells in the substantia nigra responsible for producing?
A
The nerve cells in the substantia nigra are responsible for producing the neurotransmitter dopamine.
8
Q
What is the role of dopamine?
A
Dopamine transmits messages from your brain that control and coordinate the body’s movements.
9
Q
What percentage of nerve cells in the substantia nigra are lost before Parkinson’s symptoms appear?
A
When 80% of the nerve cells in the substantia nigra become damaged or die, that’s when symptoms appear.
10
Q
What type of treatments/management are available for Parkinson’s disease?
A
- physiotherapy
- speech and language therapy
- drug treatments
11
Q
What are the common drug treatments for Parkinson’s?
A
Co-beneldopa + co-careldopa
12
Q
What is the mode of action of co-beneldopa?
A
Levodopa is converted into dopamine in the brain and replaces the lost dopamine.
Improves nerve messages sent, reduces symptoms.
Benserazide stops levodopa being converted into dopamine in the rest of the body.
Benserazide doesn’t pass into the brain.
13
Q
What is narcolepsy?
A
Narcolepsy is a long term brain disorder that causes a person to fall asleep at inappropriate times.
14
Q
What are the symptoms of narcolepsy?
A
- excessive daytime sleepiness
- sleep attacks
- cataplexy (loss of muscle control)
- sleep paralysis
- excessive dreaming and waking in the night
15
Q
Are more men or women diagnosed with narcolepsy in the UK?
A
Narcolepsy affects men and women equally.
16
Q
At what age do symptoms of narcolepsy usually appear?
A
Symptoms of narcolepsy usually begin during adolescence, and people are usually diagnosed between the ages of 20 & 40.
17
Q
What is cataplexy?
A
Cataplexy is a temporary loss of muscle control resulting in weakness & possible collapse - often in response to emotion.
18
Q
A lack of what causes narcolepsy?
A
Many cases are caused by a lack of hypocretin (orexin) which regulates wakefulness and arousal.
This is thought to occur because the immune system attacks cells that produce it. Also suggested: hormonal changes (puberty, menopause), psychological stress, swine flu.
19
Q
How is narcolepsy diagnosed?
A
- discuss sleeping habits
- carry out tests to rule out sleep apnoea, restless legs, underactive thyroid gland
- perform sleep study
20
Q
What are the treatments of narcolepsy?
A
- no current cure
- make changes to improve sleeping habits
- taking medication
- take frequent brief naps - even spaced out
21
Q
Which drugs are used to treat narcolepsy?
A
modafinil (Provigil) and methylphenidate
22
Q
What is the mode of action of modafinil?
A
Modafinil works by stimulating the central nervous system to increase your alertness and reduce excessive sleepiness.
23
Q
What is the mode of action of co-careldopa?
A
Levodopa is converted to dopamine.
Carbidopa stops levodopa being converted into dopamine in the rest of the body as this can cause unwanted side effects.
24
Q
What is obesity?
A
Obesity is excessive body fat for a given height and weight. When more calories are consumed than are actually used by the body.
25
What are the symptoms of obesity?
* inability to sustain sudden exercise
* shortness of breath
* excessive tiredness
* leg, joint and back pain
26
What are the long term health risks associated with being obese?
* high blood pressure
* high cholesterol
* breast cancer
* gastro-oesophageal reflux disease (GORD)
* arthritis
27
What causes obesity?
Obesity occurs when a person **consumes more calories than they actually need**. It is likely that **family habits of eating and exercise** are key factors in obesity.
28
What tool is used to diagnose obesity?
**Body mass index** is the most convenient tool to diagnose obesity.
29
What is an ideal BMI in the range of?
An ideal BMI is between **20 -25**.
30
How is obesity treated?
* calorie controlled diet
* increased aerobic exercise
* drug treatments
31
What is the drug treatment for obesity?
**Orlistat** is the drug treatment for obesity.
32
What is the mode of action of Orlistat?
Orlistat is **not absorbed** into the bloodstream and works locally on the **gut & the small intestine**.
It prevents the action of:
* **gastric lipase**
* **pancreatic lipase**
as these are enzymes that **break down fat** from the food we eat. Fat is immediately **excreted** in the faecal matter.
Prescribed for those with a BMI of 30 (or 28 if diabetic).
33
What are the counseling points for Orlistat?
* avoid consuming fat - urgency of getting to the loo
* not for people under 18
* avoid in caution when pregnant
* avoid if breast feeding
* contraception
* diarrhoea
34
What is dementia?
Dementia is a term given to a group of symptoms, which include:
* confusion
* memory loss
* poor concentration
35
What is dementia in those under the age of 65 known as?
Dementia that occurs before the age of 65 is known as **'early-onset dementia'**.
36
What percentage of dementia cases are due to Alzheimer's disease?
**60%** of cases of dementia are due to the brain shrinking disorder Alzheimer's disease.
37
What are the symptoms of dementia?
* confusion
* a significant reduction in memory
* problems with speech and language
* loss of interest in the outside world
* hallucinations
* changes in personality
* impaired judgement
* obsessive repetitive behaviour
* sudden anger, aggression or tearfulness
* standards of personal care and hygiene may decline
38
What drug treatments are used for dementia?
donepezil & rivastigimine
39
What is the mode of action of donepezil?
Donepezil is a **reversible inhibitor of acetylcholinesterase**. The drug works by increasing the levels of acetylcholine within the brain.
40
What is anxiety?
Anxiety is a normal response to **stress or danger**. Anxiety is a problem when it is experienced **intensely** and it **persistently** interferes with a person's daily life.
41
What is generalised anxiety disorder?
Generalised anxiety disorder is anxiety symptoms that are **present for much of the time** and are **not restricted to specific situations**.
42
What is panic disorder?
Panic disorder is **repeated panic attacks** that occur **unpredictably** and without obvious causes.
43
What are phobia disorders?
Phobia disorders is a phobia which is a **fear that is out of proportion to the situation** that causes it and cannot be explained why.
44
What is stress related disorder?
Stressful events can lead to symptoms of anxiety.
45
What are the psychological symptoms of anxiety?
* inner tension
* agitation
* fear of losing control
* feelings of detachment
46
What are the physical symptoms of anxiety?
* racing heart beat
* finding it difficult to breathe
* tremor
* sweating
* hyperventilating
47
What are the non-drug treatments of anxiety?
* counselling
* relaxation techniques
* self help groups
48
How many people are affected by anxiety?
**1 in 20 people** at any one time are affected by anxiety.
49
What are the common drug treatments for anxiety?
Citalopram & escitalopram
50
What is the mode of action of citalopram?
Citalopram **selectively inhibits** the re-uptake of **serotonin 5-hydroxytryptamine** (5-HT) in **presynaptic cells** in the CNS, it therefore **increases** levels of 5-HT within the synaptic cleft **enhancing the actions of serotonin** (uplifting feeling of wellbeing).
51
What is insomnia?
Insomnia refers to an **inability to fall asleep or to remain asleep** for an adequate length of time.
52
What causes insomnia?
**Stress & depression** are well known causes of insomnia. **Illness**, especially if there is pain or discomfort is another cause.
53
What are the types of insomnia?
* transient insomnia
* short-term insomnia
* chronic insomnia
54
What is transient insomnia?
Transient insomnia occurs in those who **normally sleep well** and may be due to factors such as **noise**, **shift work** and **jet lag**.
55
What is chronic insomnia?
Chronic insomnia is caused by **psychiatric disorders** such as anxiety, depression and abuse of drugs and alcohol.
56
How is insomnia treated (non-drug treatments)?
* write down worries rather than fret
* warm bath
* try not to eat large meals before bed
* cut down on caffeinated drinks
* do not go to bed until you feel tired
57
What is depression?
Feelings of **extreme sadness** that last for a long time. These feelings are so severe that they **interfere with daily life** and can last for weeks or months rather than days.
58
What are the psychological symptoms of depression?
* continuous low mood/sadness
* feelings of hopelessness
* low self esteem
* tearfulness
* feelings of guilt
59
What are the physical symptoms of depression?
* slowed movement/speech
* changes in appetite or weight
* unexplained aches and pains
* lack of energy
60
What are the social symptoms of depression?
* not performing well at work
* the want or need to be alone
* less socially active
61
What are the psychological causes of depression?
A psychological cause of depression could involve an **upsetting life event** that causes a **persistent low mood**, **low self-esteem** and feelings of **hopelessness** about the future.
62
What might the physical/chemical cause of depression be?
Depression can be caused by **changes in levels of chemicals** in the brain.
63
What might 'social causes' of depression be?
Doing **fewer activities** or having **fewer interests** can both cause depression and be a symptom of depression.
64
How is 'mild' depression treated?
* continual GP review
* more exercise
* increase social activity
65
How is 'moderate' depression treated?
* counselling
* cognitive behavioural therapy (CBT)
* drug treatments
66
How is severe depression treated?
* drug treatments
* CBT
* psychotherapy
* ECT (rare)
67
What are the drug treatments for depression?
Citalopram & amitriptyline
68
What is the mode of action of citalopram?
Citalopram **selectively inhibits the re-uptake of serotonin**.
69
What is the mode of action of amitriptyline?
Amitriptyline **inhibits the neuronal reuptake of serotonin & noradrenaline** from the synapse in the CNS increasing their availability in the synapse to cause neurotransmission on the post-synaptic neurone.
70
What is bipolar disorder?
Mania and depression. It is chronic and incurable.
71
What are the symptoms of bipolar disorder?
* mania - abnormally high - more talkative, delusions of grandeur, energetic, increased sex drive
* depression - loss of joy, weepiness, guilt, poor concentration
72
At what age does bipolar disorder most commonly develop?
Bipolar disorder most commonly develops between **17-29 years**.
73
What are the two types of bipolar discorder?
* type 1
* type 2
74
What is type 1 bipolar disorder?
Type 1 bipolar disorder is starting with manic or mixed episodes which both develop at some point during the condition.
75
What is type 2 bipolar disorder?
Type 2 bipolar disorder only presents with **hypomania**.
76
What are the causes of bipolar disorder?
* unknown
* ?genetics
* stress
* chemical imbalance in the brain
77
How is bipolar disorder diagnosed?
Bipolar disorder usually goes undiagnosed.
* mood questionnaire
* doctors refer to a specialist
78
What drug ***class*** treatments are there for bipolar disorder?
* lithium
* anticonvulsants
* antipsychotics
* antidepressants
* ECT
79
What is step 1 on the analgesic ladder?
Non-opiod
| (eg aspirin, paracetamol, NSAIDs)
80
What is step 2 on the analgesic ladder?
Weak opioid
for mild to moderate pain relief (eg codeine)
81
What is step 3 on the analgesic ladder?
Strong opioid
for moderate to severe pain
(eg morphine)
82
What is an adjuvant analgesic?
An analgesic adjuvant is a medication that is typically used for indications **other than pain control** but provides **control of pain** in some painful diseases.
83
What medications can be used as adjuvant therapy in pain management?
* can use antidepressants
* anticonvulsants
* corticosteroids
* muscle relaxant
* sedatives
84
What do local anaesthetics do?
Local anaesthetics are drugs that **interfere** with transmission in the **nerves** by carrying **pain impulses**.
85
What does NSAID stand for?
Non-steroidal anti-inflammatory drugs
86
What is released in response to injury?
**Prostaglandins** are released in response to injury.
87
What do prostaglandins do?
Prostaglandins cause **pain, swelling and inflammation**.
88
Which enzyme is involved in the production of prostaglandins?
**Cyclo-oxygenase** (**COX**) is an enzyme that is involved in the production of various chemicals in the body, some of which are called prostaglandins.
89
What is the mode of action of NSAIDs?
NSAIDs **block** the action of **COX enzyme** and therefore **reduce swelling** and **relieve pain**.
90
What are examples of NSAIDs?
* ibuprofen
* diclofenac sodium
* naproxen
91
What is paracetamols mode of action?
Paracetamol's mode of action is not fully understood.
It is thought to **reduce** the production of **prostaglandins** in the brain and spinal cord.
92
What is the role of prostaglandins?
Prostaglandins are produced in the body in response to injury and certain diseases. One of their actions is to sensitise nerve endings, so that when the injury is stimulated it causes pain, presumably to prevent the patient causing further damage to the area.
93
What do opioids mimic the action of?
Opioid painkillers work by mimicking the action of naturally occuring pain-reducing chemicals in the body called **endorphins**.
94
What are drug examples of opioids?
* morphine
* oxycodone
* buprenorphine
* diamorphine hydrochloride
* fentanyl
* methadone
95
What are the main side effects/problems with opioids such as morphine?
* Respiratory depression
* coma
* pinpoint pupils
96
How is opioid overdose treated?
**Naloxone** - short-acting, monitored and readministered.
97
What is given as a treatment of paracetamol overdose?
**Acetylcysteine** is given as a treatment hopefully within **8 hours** of ingestion.
98
What are the five distinct stages of a migraine?
* pre-headache or early warning stage
* aura (symptoms include visual disturbances, difficulty focusing, numbness in the arms, face tongue and lips)
* headache stage (symptoms include pulsating throbbing headache on one side of the head, nausea and vomiting, sensitivity to light and/or sound)
* resolution stage
* recovery stage
99
What causes a migraine?
The causes are unclear.
* thought that it may occur due to a **decrease in blood flow** to a part of the brain
* thought that some **chemicals** in the brain increase their activity during a migraine (however some such as serotonin and 5HT decrease at the onset of a headache)
* trigger factors
* food: cheese, chocolate, wine, citrus fruits
* exercise
* anxiety
* stress
* bright lights
* loud noise
* contraceptive pill
100
What is local anaesthesia?
Local anaesthesia is any technique used to render a part of the body **insensitive to pain without affecting consciousness**.
101
What are examples of local anaesthetics used topically?
* EMLA cream
* tetracaine eye drops
* lidocaine
102
What are examples of local anaesthetics used via infiltration?
* prilocaine
103
What are examples of local anaesthetics used via a nerve block?
* bupivicaine
* levobupivicaine
* mepivacaine
104
What are examples of local anaesthetics used via an intravenous regional block?
* lidocaine
105
What are examples of local anaesthetics used in a haematoma block?
* lidocaine
106
What is a plexus block?
A plexus block is anaesthesia along or around the **spine**.
107
What are examples of local anaesthetic drugs used in an extradural and spinal?
* bupivicaine
* levobupivicaine
* chloroprocaine
108
When is the infiltration local anaesthetic route used?
Used into the skin, to numb an area before a procedure.
109
When is a nerve block local anaesthetic used?
Utilised for minor or major nerves.
110
When is am intravenous regional block used?
Used with a tourniquet to provide anaesthesia for distal arm or leg.
111
When is a haematoma block used?
A haematoma block is used for fractures.
112
When is an extradural or spinal used?
An extradural or spinal is used in elderly patients having surgery and during childbirth.
113
Why is adrenaline used in conjunction with local anaesthetics?
The addition of a **vasoconstrictor** such as adrenaline/epinephrine to the local anaesthetic preparation **diminishes local blood flow**, slowing the rate of absorption and thereby **prolonging theanaesthetic effect**.
114
What is the major limitation of using adrenaline in conjunction with local anaesthetics?
* cannot be used in digits - ischaemic necrosis
115
Which drugs are used for IV anaesthetic?
* etomidate
* propofol
116
What is the purpose of using IV etomidate/propofol?
Induction
117
Which drugs are used for inhaled anaesthetics?
* desflurane
* isoflurane
* nitrous oxide
* sevoflurane
118
What is the purpose of using desflurane/isoflurane/nitrous oxide/sevoflurane for inhaled anaesthetics?
Inhaled induction
119
Which drugs are anti-muscarinics?
* atropine
* hyoscine hydrobromide
* glycopyrronium bromide
120
What are the purpose of anti-muscarinics?
Dry secretions
121
Which drugs are muscle relaxants?
* suxamethonium chloride
* atracurium besilate
* cisatracurium
* mivacurium
* pancuronium bromide
* rocuronium bromide
* vecuronium bromide
122
What is the purpose of muscle relaxant drugs during surgery?
Paralysis to perform surgery
123
Which drugs are used to reverse muscle relaxants?
* neostrigmine with glycopyrronium
124
Which drugs are used as anxiolytics?
* diazepam
* temazepam
* lorazepam
* midazolam
125
What is the purpose of anxiolytics?
Anxiety before surgery adjuvant
126
Which drugs are used as analgesics?
* diclofenac sodium
* paracetamol
* alfentanil
* fentanyl
127
What is the purpose of analgesics?
Pain relief
128
Which drugs are used as anti-emetics?
* granisetron
* ondansetron
129
What is the purpose of anti-emetics?
To prevent sickness during and after surgery
