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Pathophysiology and Pharmacology 2 > Disorders of Circulation in CNS > Flashcards

Disorders of Circulation in CNS Flashcards

1
Q

Ischemia

A

Obstructed blood vessels

drops blood flow in brain

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2
Q

Increased Pressure w/in Skull Caused By

A

hematoma
excessive production of cerebral spinal fluid
blockage of duct system conveying cerebral spinal fluid

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3
Q

Brain & Spinal Cord FX

A

detect/transmit/analyze sensory information
generate signals to autonomic/motor pathways
orchestrate endocrine functions/coordination/movement

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4
Q

Major Disorders

A

Transient ischemic attack (TIA)
Stroke
Subdural/Spinal Cord Hemorrhage

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5
Q

Transiet Ischemic Attack

A

brief appearance of symptoms resembling stroke

generally resolve w/in 24 hours

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6
Q

Stroke

A

brain attack

enduring disruption of speech/motor/communication/accompanied by cognitive deficits

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7
Q

Cerebrospinal Fluid Pruduced

A

in choroid plexi of ventricles

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8
Q

CSF Flows Through

A

ventricular system of brain

subarachnoid space surrounding brain & spinal cord

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9
Q

CSF FX

A

resorbed into venous dural sinuses via arachnoid villi

balance between production & absorption is critical

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10
Q

CSF Made

A

constantly
blockage = over-accumulation
increases pressure against brain

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11
Q

Blood-BrainBarrier About

A

specialized endothelium in brain capillaries
permits selective entry of substances into CNS
tight junctions between endothelial cells
active transport

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12
Q

BBB Transport (Direct)

A

highly lipophilic substances

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13
Q

BBB Transport (Simple Diffusion)

A

water

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14
Q

BBB Transport (Facilitated Diffusion)

A

most nutrients

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15
Q

Meds that typically cross BB

A

small weight anti-psychotics
sleep aids
antidepressants
98% cannot

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16
Q

Cerebral Autoregulation

A

maintains steady flow of blood to brain/spinal chord

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17
Q 
Cerebral Blood Flow
Increased BP
Decreased BP
Increased PaCo2
Decreased PaCo2
A 
arteries respond to pH/Co2/O2
constricted cerebral capillaries
dilated capillaries
dilated vessels
constricted cerebral vessels
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18
Q

If Autoregulatory Mechanisms Fail

A

loss of match between oxygen supply/demand of tissues

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19
Q

Intracrainial Pressure

A

pressure exerted by contents of cranium

compensatory relationship maintains cerebral compliance in response to changes in volume

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20
Q

Injured Brain Tissue

A

cytotoxic edema vasogenic edema

clearance of brain tissue swelling

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21
Q

Hydrocephalus

A

excessive accumulation of CSF in cranial vault that compresses surrounding structures

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22
Q

Hydrocephalus Causes

A

lesions that obstruct CSF flow

problems with resorption

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23
Q

Intracranial Pressure (ICP) NV

A

5-15 mmHG

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24
Q

Increased ICP Causes

A 
trauma
hemorrhage
growths/tumors
hydrocephalus
edema
inflammation in brain
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25
Q

Increased ICP Effects

A

impeded circulation to brain
impeded absorption of CSF
impacts fx of nerve cells
leads to brainstem compression/deat

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26
Q

Neuro Assessment

A 
Altered level of consciousness (earliest sign of increased ICP)
pupillary changes
fever
headache
nausea
vomitting
abnormal respirations
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27
Q

Later Signs of Neurological Changes

A 
elevated SBP
widened pulse pressure
bradycardia
LATE
changes in motor function 
positive babinski (toes extended)
decorticate (Cs inward)
decerebrate(Es outward)
seizures
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28
Q

Glasgow Coma Scale uses

A 
gauge impact of acute brain trauma
vascular injury/infection
hepatic/renal failure
hypoglycemia
diabetic ketoacidosis
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29
Q

Glasgow Coma Scale
Severe
Moderate
Mild

A

<8
9-12
13-15

30
Q

Elevated ICP Intervenions

A 
avoid increasing intra pressure (straining/coughing/blowing nose)
head of bed 30-40 degrees
head in neutral position
avoid flexion of neck/hips
minimal stimuli
bring items closer to prevent reaching
31
Q

Hydrocephalus Etiology/Patho

A 
imbalance of I/O CSF flow
blockage of CSF through ventricles
Inhereted genetic abnormalities/developmental disorders (ex spina bifida)
complications of premie birth
intraventricular hemorrhage
meningitis
tumors
traumatic head injury
subarachnoid hemorrhage
32
Q

Hydrocephalus Infants S/s

A 
rapid increase of head circumference
unusually large head size
vomiting
sleepiness
irritability 
downward deviation of eyes (sun setting)
seizures
33
Q

Hydrocephalus Adults s/s

A 
skulls cannot expand
headache w/ vomiting
nausea
blurred/double vision
sun setting
balance issues
poor coordination
gait disturbance
urinary incontinence
slow/loss of development
lethargy
drowsiness
irritability 
personality/cognition changes
memory loss
34
Q

Hydrocephalus TX

A 
Ventriculoperitoneal (VP) shunt placed
CT scan for FX/malfunction
medication (controversal)
only temporary 
acetazolamide
furosemide
35
Q

Carbonic Anhydrase Inhibitor (class/ex/moa/actions)

A

anticonvulsant
acetazolamide
inhibits carbonic anhydrase from catalyzing hydration/de of CO2 to carbonic acid
controls fluid secretions
promotes diuresis in abnormal fluid retention
used in glaucoma tx

36
Q

acetazolamid SE/BBW/Contra/Intx/Preg

A 
Stevens-Johnson syndrome 
toxic epidermalnecrolysis (TEN) acidosis
agranulocytosis
hepatic necrosis
NONE
cirrhosis, hypokalemia, hyponatremia, renal dysfunction, suprarenal gland failure
can inhibit renal excretion of basic drugs/promote acidic drug release, increase salicylate toxicity (acidosis)
C
37
Q

Brain use of Total Cardiac Output/Body’s Oxygen Consumption

A

15%

20%

38
Q

Cerebral Blood Flow

A

Cerebral Vascular Resistance (CVR) x Cerebral Perfusion Pressure (CPP)

39
Q

Mitochondrial Dysfunction

A

leads to infarction/tissue death

anaerobic glycolytic pathways initiated

40
Q

Energy Deprivation/Loss of Ion Homeostasis

A

cells can’t maintain negative membrane potential
excitatory amino acids in extracellular space
glutamate/influx of CA ions
apoptosis

41
Q

Cerebral Hemorrhage in Sepsis

A

immune cells activated
leukocytes enter brain
inflammatory agents contribute to brain inflammation
nitric oxide/nitric oxide synthetase pathway
mitochondrial dysfunction/apoptosis

42
Q

Stroke (Ischemic vs Hemorrhagic)

A

interruption in blood supply to region of the brain or bleeding in vessel resulting in tissue damage or infarction
87% vs 13%

43
Q

Stroke s/s

A

sudden onset of focal neurologic deficit persisting for at least 24 hours
depend on area affected

44
Q

Stroke Patho/Causes

A

partial or complete occlusion of cerebral blood flow due to thrombus/embolus
atherosclerosis
cardiac disorders
thrombotic strokes (internal carotid artery, middle cerebral artery, basilar artery)

45
Q

Stroke Hemorrage Causes

A 
burst blodo vessel (intracerebral/intraventricular/extracerebral)
subarachnoid hemorrhage
cerebral aneurysm
ischemic conversion
arteriovenous malformations (aVMs)
46
Q

Ischemic Stroke TX

A 
restoration of blood flow/reduce area effected
supplemental o2
glycemic control
fibrinolytic therapy
antihypertensive therapy
aspirin 325 mg
hypothermia
blood pressure control
47
Q

Hemorrhagic Stroke TX

A 
osmotic diuretics
blood pressure control
surgical evacuation
craniotomy w/ aneurysm clipping
endovascular therapy w/ coil embolization
delayed cerebral ischemia (DCI)
48
Q

Penumbra

A

tissue surrounding infartction

49
Q

Osmotic Agent (class/ex/moa/actions)

A 
Diuretic
mannitol
promotes diuresis by increase ECF osomolarity
tx cerebral edema/acute glaucoma
increase in plasma oncotic pressure
50
Q

Mannitol (SE/BBW/Contra/In/Preg)

A 
GI symptoms
Dizziness
CHF
Compartment Syndrome
injection site extravasation
Fluid/Elec Imbalance
Acute injury of Kidneys
Pulmonary Edma
Coma Seizures
^ Dose = ^ risk of kidney disease/fluid overload (life-threatening pulmonary edema)
[Severe Bronchospasms]
anuria/aortic&amp;cerebral aneurysm/uncontrolled HTN/recent MI or CVA/severe hypovolemia/dehydration/active intracranial bleed/pulmonary edema
Tobramycin = ototoxicity
fetal risk can't be ruled out
51
Q

Fibrinolytic Therapy

A

clot removal w/in 24-48 hrs of formation

52
Q

Tissue Plasminogen activator (TPA) alteplase (Activase)

A

TPA converts plasminogen to plasmin
Plasmin digests fibrin strands restoring circulation
regulates unwanted clots, fibrin remains

53
Q

Blood Modifier Agent (Class/ex/Moa/Actions)

A

Tissue plasminogen activator
alteplase
enhances conversion of plasminogen to plasmin biding to fibrin (initiating fibrinolysis)
TX acute MI/ischemic, acute CVA/pulmonary embolism/central venous catheter occlusion

54
Q

Alteplase (SE/BBW/Contra/IX/Preg)

A

Can Cause intercranial Hemorrhage (frequent neuro checks 15 min/signs of increased ICP like headache)
Angioedema/allergic rx
Once started do not insert additional IV/catheter
NONE
active internal bleeding/intracranial hemorrhage, AVM, bleeding diathesis, severe uncontrolled HTN/subarachnoid hemorrhage/within 3 months of cranial or spinal surgery or serious head trauma
anticoagulants/antiplatlets = increased risk of bleeding
ace-inhibitor = angioedma
fetal risk cannot be ruled out

55
Q

Anti-Platelet Therapy (moa/primary use/medications/nursing)

A

alters plasma membrane of platelets so they cannot aggregate
prevent thrombi formation after stroke of MI
aspirin clopidogrel
monitor for bleeding/prolonged pressure needed w/ puncture sites

56
Q

Clopidogrel (moa/uses)

A

inhibits platelet aggregation by selectively bonding to receptors on platelets
prevents thrombi formation after stroke or MI

57
Q

Clopidogrel (SE/BBW/Contra/INtX/Preg)

A

bleeding (can be fatal)
epistaxis
hematuria
bruising
ulcers
TTP
[diminished antiplatelet effect if 2 loss of function alleles of CYP2C19 gene]
active bleeding, peptic ulcer, intracrainial hemorrhage
omeprazole (cyp2c19 inhibitors), NSAIDs/warfarin/SSRIs/SNRIs
Fetal risk can’t be ruled out

58
Q

Transient Ischemic Attack (TIA) CAuse

A

temporary episodes of neurologic dysfunction

focal brain/spinal cord/retinal ischemia wout acute infarction

59
Q

TIA s/s

A 
facial dropping
arm/leg weakness on one side of body
speech difficulty
sudden trouble seeing in one or both eyes
difficulty walking w/ dizziness
lack of balance/coordination
severe headaches
60
Q

TIA Risk Factors

A 
age
family 
prior TIA/stroke
race
sex
sickle cell
MODIFIABLE: cardiovascular disease
carotid artery disease
diabetes
excess weight
high blood pressure 
high cholesterol
smoking
heavy drinking
physical inactivity
poor nutrition 
use of birth control pills
61
Q

TIA DX/TX

A 
exclusion of conditions that mimic TIA
BG/blood tests to rule out
electrocardiography
noncontrast CT
MRI w/ diffusion-weighted imaging
CT angiogrpahy/magnetic resonance angiography
carotid doppler
62
Q

Subdural Hematoma

A

bleeding from bridging veins between dura mater/arachnoid membrane

63
Q

Subdural Hematoma Patho Causes

A

trauma from high-speed impact to skull
spontaneous
acute (bleeding identified immediately after injury)
chronic (brain atrophy)

64
Q

Subdural Hematoma s/s

A 
headache
confusion
changes in behavior
dizziness
nausea
vomiting
lethargy
excessive drowsiness
weakness
apathy
seizures
65
Q

Subdural Hematoma TX

A

surgery

66
Q

Spinal Cord Hemorrhage Patho

A 
rare
trauma
vascular malformation
bleeding disorders
epidural/subdural/subarachnoid/intramedullary
67
Q

Spinal Cord Hemorrhage s/s

A

sudden/severe back pain w/ or w/out radiculopathy
headache
neck stiffness
photosensitivity
irreversible sensory loss below level of bleed

68
Q

Spinal Cord Hemorrhage TX

A

subdural: surgical decompression
subarachnoid: surgical resection
catheter-based interventional techniques
focal radiation w/ gamma knife/cold photon knife

69
Q

First Question to ask

A

When was the last well?

70
Q

Hypoglycemia can

A

Mimic the s/s of a stroke

71
Q

24 Hours post Ischemic Stroke

A

TPA cannot be used for fear of causing a hemorrhagic stroke

Pathophysiology and Pharmacology 2 (27 decks)

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