AMS 2 Flashcards
(44 cards)
1
Q
Sxs of what?
- Autonomic hyperactivity (diaphoresis, tachycardia, systolic HTN)
- Tremors
- Insomnia
- Transient hallucinations
- Nausea or vomiting
- Psychomotor agitation, restlessness
- Anxiety
- Seizures
- Loss of appetite / rejection of all food
- Confusion
A
Acute Alcohol Withdrawal
2
Q
Tx what w/ Benzos??
AMS is never tx w/ Benzos, but this is the 1 exception.
A
Acute Alcohol Withdrawal
3
Q
Result of what?
- Medical emergency manifest by extreme autonomic hyperactivity w/ delirium
- Can have psychosis, agitation, withdrawal seizures
- Hyperadrenergic activity –> cause of mortality (if not tx appropriately)
A
Delirium Tremens (DTs)
(Severe Alcohol Withdrawal)
4
Q
W/ Delirium Tremens from Severe Alcohol Withdrawal, what is the usual cause of mortality if pt is not treated appropriately?
A
Hyperadrenergic activity
5
Q
Wernicke’s Encephalopathy
- Medical emergency caused by ____.
- Characterized by what 3 things?
- Most cases associated w/ which 2 things?
A
- Thiamine deficiency
- Ophthalmoplegia / Ataxia / Confusion
- Alcoholism / Malnutrition (or both)
6
Q
Failure to tx/recognize Wernicke’s Encephalopathy may result in which 2 things?
A
- Death
- Permanent neurologic impairment
7
Q
Wernicke’s Encephalopathy
- What are the 2 main treatments?
- Tx if associated w/ ETOH?
A
- Thiamine & Multivitamin
- Benzos if ETOH
8
Q
A toxin of AMS called Anti-Freeze
A
Ethylene glycol
9
Q
2 types of tests for AMS to test for Toxins
A
- Urine Drug Screen
- Serum Screening
10
Q
Which test?
- Opioids
- Benzos
- Cocaine
- THC
- Barbiturates
- Amphetamines/Methamphetamines
- TCAs
- Buprenorphine
A
Urine drug screen
11
Q
Which test?
- Acetaminophen
- Salicylate
- Carboxyhemoglobin
- Digoxin
- Lithium
- Valproic acid
- Iron
- Ethylene glycol
- Lead / mercury
A
Serum screening
12
Q
Management of AMS
Address the ABCs:
A
- Airway
- Breathing
- Circulation
13
Q
What 7 things need to be addressed before initiating interventions for AMS?
A
- VS
- mental status
- Pupil size
- skin temp
- pulse ox
- cardiac monitoring
14
Q
Why do you give Thiamine in the SNOT cocktail before giving glucose?
A
To avoid inducing Wernicke-Korsakoff Syndrome
15
Q
Tx of AMS is: Identify underlying cause and tx this underlying cause
- what is the “SNOT” cocktain for pts w/ AMS?
A
- Sugar (glucose)
- Naloxone (Narcan)
- Oxygen
- Thiamine
16
Q
Which condition?
- A progressive intellectual decline
- NOT due to delirium or psychiatric disease
- 4 types
A
Dementia
17
Q
- 5 risk factors of Dementia
- What are the 4 types?
A
- Age >65
- Family hx
- Vascular Disease
- DM
- Hx of significant head injury
Four Types:
- Alzheimers (MC)
- Vascular dementia
- Dementia w/ Lewy Bodies
- Frontotemporal dementia (Luis)
18
Q
Dementia
- Typically begins after age ___.
- Prevalence doubles every __ yrs after age ___.
- By ___ y/o approximately 50% have some form of dementia
- Cause is mostly acquired or genetic?
- More prevalent among men or women?
A
- 65
- 5 years after age 65
- 85 y/o
- Acquired, (some genetic for early onset)
- Women
19
Q
_____ is the most common form of dementia.
- Major public health issue
- How is definitive dx made?
- What is the only therapy available?
A
Alzheimer Disease
- Autopsy or brain biopsy
- Symptomatic therapies
20
Q
Which condition?
- Type of progressive dementia caused by microscopic deposits that damage brain cells over time
A
Dementia w/ Lewy Bodies
21
Q
Lewy Bodies are found in Dementia w/ Lewy Bodies and what other 2??
A
- Alzheimer Disease
- Parkinson Disease (more common in this one)
22
Q
Dementia w/ Lewy Bodies
- Deposits of beta-amyloid?
- Twisted fiber of tau protein?
A
- Plaques
- Tangles
23
Q
Which condition?
- Caused by impaired blood flow to the brain
- Often occurs after stroke
- Multifocal ischemic change
- “dramatic onset” - Impairment is often more sudden than Alzheimer Dz
A
Vascular Dementia
24
Q
3 risk factors of Vascular Dementia
A
- HTN
- HLD
- Smoking
25
Dementia have short or long term memory loss?
Short
26
* Pts w/ ____ are susceptible to episodes delirium.
* Recognition of ____ is not possible until \_\_\_\_\_.
* ___ is typically dx in what setting?
* Pt should be stable when diagnosed, not acutely ill.
* Dementia
* Dementia / the delirium lifts
* Dementia / Outpatient setting
27
* ____ can lead to impaired cognition in patients w/ depression or anxiety
* (--\> poor ___ and \_\_\_\_)
* ___ sxs should improve w/ tx
* Can be early symptom of \_\_\_\_\_\_.
* If untreated, _what disorder_ may predispose an individual to age related dementia?
* **Psychiatric disease**
* poor focus & concentration
* psychiatric sxs
* dementia
* Persistent modd disorder
28
Although ____ and/or ___ are signs of both Delirium and Dementia, these are different conditions.
* Confusion &/or Disorientation
29
* Acute confusional state
* Is potentially reversible
* Usually occurs over a period of days to months
Delirium
30
* Slow & insidious
* Progresses slowly over months to years
* NOT reversible
* (can slow sxs w/ meds, but cannot be cured)
Dementia
31
* What needs to be established when pt presents w/ Dementia?
* Document pt's current ability to complete \_\_\_\_.
* Time of symptom onset
* Activities of daily life (ADL)
32
**Dementia psych workup:**
* \_\_\_\_
* Periodic screening for pts ___ y/o or over
* Evaluation by \_\_\_\_\_\_.
* MMSE
70
* trained neuropsychologist
33
**What test for Dementia is indicated if:**
* Pts w/ new / progressive complaint
* ___ is preferred test
* ____ is used to r/o amyloid pathology
**Brain imaging**
* MRI preferred
* Positive-emission tomography (PET)
34
7 labs to obtain for Dementia workup
* Serum B12
* TSH
* RPR
* CBC
* CMP
Lipids
* ApoE gene testing
35
What lab should you order if Alzheimer disease is in differential? Why?
ApoE gene testing (esp young patients bc/ good to catch early to tx)
36
2 treatments for Dementia
* Aerobic exercise (45 mins)
* Frequent mental stimulation
37
Tx for Dementia w/ Lewy Bodies
(Small effect on cognition, mood, behavior)
Memantine
38
3 treatments for Alzheimer Disease and what type of drug they are.
**Cholinesterase Inhibitors**
* Donepezil (mild to moderate dz)
* Rivastigmine
* Memantine (moderate to severe dz)
39
**Mood/Behavioral tx for Dementia**
* _____ are generally safe
* Avoid ____ due to anticholinergic effect
* _____ for insomnia
* SSRI
* Paroxetine
* Trazadone
40
What is the name of a Psychostimulant used for apathy for select patients w/ Dementia?
Methylphenidate
41
* ____ is the most common cause of rapidly progressive dementia
* ___ gene can test for familial susceptibility for ____ disease
* Creutzfeldt-Jakob disease
* PRNP / Prion Disease
42
Driving and Dementia
* Recommended to stop driving
* Most states have laws concerning dementia/driving
43
**Dementia**
* Admit all pts w/ ____ to tx underlying cause
* Refer all pts w/ new cognitive decline to \_\_\_\_.
* delirium
* Neurology
44
