Module 3 - Neurology and Pharmacology Flashcards
(21 cards)
Discuss the features and utility of the Glasgow Coma Score
Discuss the organization of the nervous system
CNS
-> Brain
-> Spinal cord
PNS
->Sensory
—> Special senses (sight, smell, hearing)
—> General (somatic, visceral)
-> Motor
—> Somatic
—> Autonomic
——> PSNS (Rest or digest)
——> SNS (Fight or flight)
Discuss the features of pain transmission
Pain Pathway: transduction, transmission, perception, modulation
Transduction
- Noxious stimuli => cell damage => release of substance P, prostaglandins, histamine etc.
- Activates sensory impulse
Transmission
- Sensory signal travels up 1st order neuron
- Synapses with 2nd order neuron in dorsal horn of spinal cord
- Travels up spinal cord, through brainstem, to thalamus
Perception
- From the thalamus, the 2nd order neuron synapses with a 3rd order neuron which travels to the cortex
- The area of the cortex correlates to area in pain => stimulus perceived
Modulation
- 1st order neuron originating in periaqueductal grey in the midbrain activated
- This synapses with 2nd order neuron in nucleus raphe magnus in the medulla
- 2nd order neuron is a serotonergic and noradrenergic neuron
- 2nd order neuron reaches the dorsal horn where it releases Norad and 5HT
- Norad and 5HT interacting with ascending 1st order neuron to reduce calcium influx preventing neurotransmitter (substance P) release
- Norad interacts with an opioid interneuron to release encephalin endogenous opioid
- Encephalins interact with mu opioid receptors on the ascending 2nd order (post synaptic) neuron
- This results in K+ influx, hyperpolarising the cell, reducing pain transmission
Discuss considerations relating to the actions and out-of-hospital decision making of different types of patient analgesia
Discuss the features of a ROSIER + ACT assessment
Discuss the pathophysiology, features, and out-of-hospital management of cerebrovascular accident
Discuss the pathophysiology, features, and out-of-hospital management of head injuries
Discuss the pathophysiology, features, and out-of-hospital management of spinal injuries
Discuss the pathophysiology, features, and out-of-hospital management of seizures
Discuss the pathophysiology, features, and out-of-hospital management of narcotic overdose
Discuss the indications, contraindications, and precautions of the use of adrenaline
Discuss the indications, contraindications, and precautions of the use of amiodarone
Indications: VT/VF, unstable tachyarrhythmia
Contraindications: 2/3rd drgree AV block
MOA
- Blocks K+ channels slowing repolarisation
- Lengthens absolute refractory period preventing AP
Dose
- 150mg
- 300mg
Discuss the indications, contraindications, and precautions of the use of atropine
Indications: bradyarrhythmia, OP poisoning
Adverse effects: hallucinations, seizure, rebound bradycardia, tachyarrhythmia, hypoglycaemia/kalaemia
MOA
Anticholinergic - reversibly antagonises parasympathetic muscarinic ACh receptors - prevents parasympathetic innervation to heart i.e., slowing of HR - speeding up HR
Dose
- 500-600mcg IV
- repeat up to max 3mg
- If unsuccessful, adrenaline infusion 2-10mcg/min
- Glucagon in suspected beta blocker/calcium channel blocker OD
- If all unsuccessful -> pacing
Discuss the indications, contraindications, and precautions of the use of adenosine
Indications: SVT, (AVNRT/AVRT)
Contraindications: Asthma/COPD, severe hypotension, CHF, 2nd and 3rd degree AV block
Precaution: lung diseases -> bronchoconstriction
MOA
- Works of A1 and A2 adenosine receptors
- Forces potassium efflux and calcium influx to hyperpolarise cell and allow for slowed conduction
- Creates a transient heart block - resolves after 10 seconds due to short T1/2
- Allows for smooth muscle relaxation -> vasodilation
-» antiarrhythmic effects
Dose
- 6mg rapid push
- Repeat at 12mg
- Repeat once more at 12mg
- ?cardioversion
Discuss the indications, contraindications, and precautions of the use of glyceryl trinitrate
Indications
- ACS (MI, Angina)
- ACPO
- Autonomic dysreflexia
Contraindications
- Preload dependent rhythms (AF)
- Bradycardia
- Hypotension
- R sided MI
MOA
- GTN -> blood = nitrate ion
- Nitrate ion + enzyme = NO
- NO is a hydrophobic gas - diffuses into vein smooth muscle cells
- In cell, results in increase in cGMP
- cGMP allows for decrease in actin-myosin interactions => decrease smooth muscle contraction ==» vasodilation
- cGMP also leads to decreased calcium in the cytosol => vasodilation
Discuss the indications, contraindications, and precautions of the use of salbutamol
Discuss the indications, contraindications, and precautions of the use of ipratropium bromide
Discuss the indications, contraindications, and precautions of the use of midazolam
Discuss the indications, contraindications, and precautions of the use of naloxone
Discuss the indications, contraindications, and precautions of the use of droperidol
Discuss the indications, contraindications, and precautions of the use of tranexamic acid
