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Pathopharmacology Intro > Module 4 > Flashcards

Module 4 Flashcards

1
Q

What is hyperactive confusional state? How long does this develop over?

A

Acute disturbances in attention / awareness - develops over 2-3 days

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2
Q

What are the risk factors for hyperactive confusional state?

A

Medications, acute infection, surgery, hypoxia, electrolyte imbalances, and insomnia

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3
Q

How does hyperactive confusional state manifests?

A

Restless, irritable, difficulty concentrating, insomnia, tremors, poor appetite

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4
Q

What is fully developed delirium?

A

Hallucinations, completely inattentive, grossly altered perception

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5
Q

What is excited delirium syndrome

A

Combative, aggressive, pain, rapid breathing, can lead to death

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6
Q

How to treat hyperactive confusional state

A

Remove risk factors when possible

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7
Q

What is hypoactive confusional state associated with?

A

Right sided frontal basal-ganglion disruption

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8
Q

How does hypoactive confusional state manifest?

A

Decreased alertness and attention span, forgetfulness, apathetic, slow speech, frequently falls asleep

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9
Q

How do you treat hypoactive confusional state?

A

Remove causative agents if possible

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10
Q

Compare the onset of delirium and dementia

A

Dementia: slow and progressive
Delirium: acute (r/t hospitalizations)

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11
Q

Compare the course of delirium and dementia

A

Dementia: chronic, slow decline
Delirium: fluctuating and reversible

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12
Q

Compare the attention level for delirium and dementia

A

Dementia: intact early but declines later
Delirium: inability to focus or sustain attention

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13
Q

Compare the alertness and orientation level of dementia and delirium

A

Dementia: intact early and can be variable in later stages
Delirium: impaired

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14
Q

Compare the behavior between dementia and delirium

A

Dementia: intact early on
Delirium: agitated, withdrawn, depressed

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15
Q

Compare the speech habits between delirium and dementia

A

Dementia: word finding problems / aphasia
Delirium: incoherent, disorganized

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16
Q

What are the risk factors for Alzheimers

A

65+, family hx, existing mild cognitive impairment, head trauma, and isolation

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17
Q

What is the patho behind Alzheimers

A

Accumulation of neuritic plaques and intraneuronal neurofibrillary tangles of tau protein

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18
Q

In frontotemporal dementia what is progressive non-fluent behavior and semantic dementia

A

Progressive : problems with language and writing
Semantic: problems forming words and sentences

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19
Q

What is dopamine responsible for

A

pleasure, satisfaction

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20
Q

what is norepinephrine responsible for

A

increases alertness, arousal, and attention

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21
Q

what is serotonin responsible for

A

mood, sleep, sexual desire

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22
Q

what is GABA responsible for

A

reduces neuronal excitability by inhibiting nerve transmission

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23
Q

How does a dopamine deficit manifest

A

parkinson’s like symptoms and pleasure center dysfunction

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24
Q

how does a serotonin deficit manifest

A

OCD like symptoms and impulsivity

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25
together how do serotonin and dopamine deficit manifest
depression and cravings
26
what is anticipatory anxiety
fearful expectation of panic anxiety onset
27
what is avoidance anxiety
personal strategies used to increase feelings of control and decrease the risk of panic
28
what is used as a second line therapy for panic disorders
benzos
29
what is generalized anxiety disorder and how long does it take to be diagnosed
excessive, uncontrolled, unrealistic worry accompanied by muscle tension, autonomic hyperactivity, exaggerated startle, difficulty concentrating anxiety present for more than 6 months
30
what are the risk factors for GAD
excessive use of certain substances, childhood abuse / family trauma, genetics
31
what are the key characteristics of PTSD
vivid flashbacks, nightmares, emotional blunting, irritability, and exaggerated startle
32
what are the 4 main causes of PTSD in men and women
Men: rape, combat, childhood neglect, and childhood physical abuse Women: rape, sexual molestation, physical attack, being threatened with a weapon
33
If a person takes propranolol for social anxiety how long before should they take it?
1-2 hours before
34
compare obsessions and compulsions
obsessions - repetitive unwanted thoughts compulsions - repeated activities or rituals
35
What is a second line treatment (pharm) for OCD
Clomipramine
36
How does the brain pathways change with addiction
Addiction decreases dopamine pathways but with abstinence they do regenerate
37
What are the risk and protective factors of substance abuse?
Risk: aggressive behavior as children, lack of parental supervision, poor social skills, drug experimentation, availability of drugs at school Protective: good self control, parental monitoring and support, positive relationship, good grades, school anti-drug policies
38
What is the safest way to manage acute withdrawal symptoms
medically assisted detoxification
39
treatment programs for substance use also need to test patients for what
diseases that are associated with substance use disorders - like HIV / ADIS, hepatitis, TB, and endocarditis
40
Antagonist or agonists - for buprenorphine and naloxone
Buprenorphine: partial opioid agonist Naloxone: opioid antagonist
41
What is the opioid withdrawal timeline
begins 12-24 hours after last dose, peaks at 72 hours, physical symptoms start to lessen at 1 week cravings and depression can last through months
42
What is included in supportive treatment for opioid withdrawal
Tylenol and anti-diarrhea
43
what are the serious symptoms related to benzo and alcohol withdrawal
seizures, hallucinations, delirium tremens (tachycardia, hypertension, fever, agitation, diaphoresis), wernikes encephalopathy (profound disorientation, inattention, oculomotor dysfunction)
44
What is the benzo withdrawal timeline
first symptoms start 6-12 hours after last dose, peaks at 2 weeks
45
what is the alcohol withdrawal timeline
8 hours - anxiety, insomnia, nausea, and abdominal pain 1-3 days is the peak - high blood pressure, increased body temperature
46
with alcohol withdrawal what vitamin needs supplementation
B1
47
What is the purpose of acute pain
protective, promotes withdrawal from painful stimuli, teaches avoidances, allows injured parts to heal
48
what are the three pathways that are involved with pain sensation, perception, and response
afferent pathways - take impulses from spinal cord to cortex interpretive centers - interpret impulse as pain efferent pathways - physical / mental response to pain
49
what is nociceptive pain
stimuli of a certain intensity that causes or could potentially cause tissue injury
50
what happens at the transduction phase of pain
stimuli converted to action potentials - happens at A-delta and C-fibers
51
What does prostaglandin do when activated
lowers the pain threshold - when prostaglandin is suppressed it decreases the pain by raising the pain threshold. promotes inflammation, pain, and fever protects lining of stomach from acid, promotes clotting factors (activates platelets), and affects kidney function
52
what fibers are myelinated
a-delta
53
what fibers are non-myelinated
C-fibers
54
if pain activate the a-delta fibers what does the pain feel like
sharp, stinging, cutting, and pinching - these are localized
55
if pain activates the c-fibers what does the pain feel like
dull, burning, aching - these are poorly localized
56
what fibers do not transmit pain
A-alpha and A-beta
57
compare tolerance and threshold in relation to pain
tolerance - greatest intensity of a pain a person can handle threshold - lowest intensity of pain that a person can recognize
58
intense pain at one location may decrease or increase the pain threshold in another site
decreases
59
what is the gate control theory
if we block the pain before it gets to the brain we can stop/lower the pain perception
60
pain < 3 months is considered
acute
61
pain >3-6 months is considered
chronic
62
what type of pain stimulates the ANS
acute - can change HR, BP, sweating, and cause dilated pupils
63
compare the stimuli for nociceptive and neuropathic pain
nociceptive - outside the CNS neuropathic - inside the CNS
64
compare the causes of nociceptive and neuropathic pain
nociceptive - activated in response to actual / impending tissue injury neuropathic - arises from direct injury to NERVES
65
visceral pain activates only which pain fiber
C
66
cutaneous / somatic pain involves what system and has what complaints
musculoskeletal pain constant, achy
67
what is the localization of cutaneous / somatic pain
well localized in skin and subcutaneous tissue but less well localized for bones
68
visceral pain involves what system and has what complaints
involves organs cramping, splitting, N/V, diaphoresis
69
what is the localization of visceral pain
poorly localized
70
neuropathic pain involves what system and has what complaints
nerves shooting, burning, electric shock, sharp, numb, weakness
71
what is the localization of neuropathic pain
poorly localized
72
compare referred and phantom pain
referred - pain felt at a distance from the actual pathology (common in visceral pain) phantom - sensation of pain that originates from an amputated part
73
nonselective COX inhibitors decrease what
gastric acid protection and platelet function
74
does acetaminophen have anti-inflammatory effects
no
75
what enzyme is responsible for the production of prostaglandins
COX
76
chronic alcohol users should limit their acetaminophen to how much
2 g / day
77
when administering an opioid when should you wait and assess for level of sedation
if RR is less than 10
78
how does initial drowsiness change with more doses of opioids
diminishes
79
0.1 mg of IV fentanyl is how much morphine
10 mg IV morphine
80
define myoclonic
brief, shock-like jerks of a muscle of groups
81
what is the cause of primary seizures
don't know the cause - they are idiopathic
82
what is the etiology of secondary seizures
chemical imbalances, fever, brain injuries
83
What is the caveat to diagnosing epilepsy
must have no evidence of a reversible metabolic cause
84
what is seizure threshold
persons likelihood to have a seizure
85
what is a generalized onset seizure
neuronal activity simultaneously in both hemispheres on the brain
86
tonic vs clonic
tonic - prolonged skeletal muscle contraction clonic - alternating skeletal muscle contraction and relaxation
87
what are absence seizures
brief loss of awareness that commonly occurs with repetitive spasmodic eyes blinking for up to 30 seconds
88
what is a focal onset seizure
seizure originating in a localized part of the brain (one lobe)
89
what is the prodromal phase of seizure
signs / activities that usually come before a seizure starts
90
what is that aural, ictal, and post-ictal phases of seizures
aural - sensory warning ictal - seizure post-ictal - recovery
91
what is status elipepticus
a continuing series of multiple seizure without a recovery period, lasts 30 minutes or more and can lead to respiratory arrest
92
how long must a patient go without a seizure to be be eligible to decrease dose or stop their anti-epileptic meds?
1-2 years
93
are pregnant women able to take anti-epileptic drugs
no, they are teratogenic

Pathopharmacology Intro (6 decks)

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