Neuro Flashcards
(156 cards)
1
Q
Anterior white commissures (what crosses here?)
A
Pain and temperature tracts (Commonly compressed in a syringomyelia — loss of pain and temp in upper extremities due to syrinx at C8-T1)
2
Q
What do the lateral hypothalamic tracts contain?
A
Sympathetics to the face (lesion= Horner’s syndrome)
3
Q
Signs of a LMN lesion?
A
Muscle weakness, atrophy, fasciculations, decrs tone & hyporeflexia
4
Q
Signs of an UMN lesion?
A
Increased tone, hyperreflexia (spasticity),clonus, Babinski sign, posturing
5
Q
Autosomal recessive, triplet repeats in the Frataxin gene Progressive damage to the nervous system Spinal nervous tissue degenerates over time causing ataxia, speech problems, muscle weakness, vision, hearing impairment Also assoc with development of diabetes and heart disease
A
Friedrich’s Ataxia
6
Q
Secondary structures of proteins (alpha helices and beta sheets) are held in tact by what type of bond?
A
Hydrogen bonds
7
Q
Melanocytes are derived from what?
A
Neural crest cells
8
Q
a monocular scotoma is caused by a lesion ______
A
at the retina, optic disk or optic nerve (possible causes include Macular degeneration or optic neuritis)
9
Q
Right anopia is caused by a lesion at the _____
A
right optic nerve (retinal artery or central vein occlusion)
10
Q
Bitemporal hemianopia is caused by a lesion at the ______
A
Optic chiasm (pituitary tumor, craniopharyngioma or aneurysm of anterior communicating artery)
11
Q
Right nasal hemianopia is caused by a lesion at the ________
A
right peri-chiasm (caused by a calcification or aneurysm of the internal carotid artery pressing on uncrossed lateral retinal fibers)
12
Q
Left homonymous hemianopia (with a Marcu Gunn pupil) is caused by a lesion __________
A
Right optic tract or optic radiation (occlusion of anterior choroidal artery or MCA branch)
13
Q
Left homonymous superior quadrantanopia is caused by __________
A
a lesion in the right temporal lobe (Meyer’s loop) – caused by a lesion / stroke in temporal lobe
14
Q
Left homonymous inferior quadrantanopia is caused by __________
A
right parietal lobe lesion or stroke
15
Q
left homonymous hemianopia w/ macular sparing caused by _________
A
right primary visual cortex (occipital lobe) – caused by a PCA occlusion, macula is spared b/c of collateral blood flow
16
Q
What are the afferent & efferent nerves for the corneal reflex?
A
CN V (sensation of eye) , CN VII (reflex blink)
17
Q
pt with hearing loss, tinnitus, asymmetric smile and loss of corneal reflex on same side—> a mass is most likely located ___________
A
at the cerebellopontine angle (the location of CN VIII…… CN V and VII are also nearby & could be affected)
18
Q
Demyelination decreases the _________ constant
A
space (aka ‘length’) constant —> the distance along the axon the AP can propogate
19
Q
Which muscle close the jaw?
A
masseter, medial pterygoid & temporalis muscles (supplied by the 3rd division of the Trigeminal n.–V3)
20
Q
Which muscle opens the jaw?
A
Lateral pterygoid muscle (CN V3)
21
Q
Which nerve roots produce ‘saddle anesthesia’ if pinched?
A
S3,4,5
22
Q
low back pain radiating to legs, saddle anesthesia, loss of anocutaneous reflex, bowel & bladder dysfunction, loss of ankle jerk reflex and weak plantarflexion of the foot
A
Cauda equina syndrome (damage to the lumbar plexus nerve roots)
23
Q
Man with short term memory loss, nystagmus, ophthalamoplegia & ataxia who’s breath smells like alcohol….. which of the structures is most likely damaged in this man’s brain?
A
B- the mammillary bodies –> he is experiencing Wernicke Encephalopathy and could progress to Korsakoff psychosis
24
Q
CSF flows from the lateral ventricles to the 3rd ventricle via __________________ and then to the 4th ventricle via the _______________ and then out of the 4th and into the subarachnoid space through the __________ & __________
A
interventricular foramina of Monroe , cerebral aquaduct , lateral foramina of Luschka (2) or the medial foramin of Magendie
25
a condition that occurs in overweight young females and is related to decreased CSF outflow at the arachnoid villi & increased ICP causing headache/ vision changes
Psuedotumor cerebri
26
Increased CSF volume occuring when there is brain atrophy
Hydrocephalus ex vacuo
27
What is the structure with the black arrow? And what disease usually affects it?
the Putamen --\> Wilson's dz causes cystic degeneration of the putamen as well as other basal ganglia structures
28
Name structures A-E
A= Globus pallidus
B = Putamen
C= Internal Capsule
D = part of the Caudate
E= Amygdala
29
What supplies sensory innervation to the tongue?
Anterior 2/3 = mandibular div of trigeminal (V3)
Posterior 1/3 = CN IX
Tongue root = CN X
30
What supplies TASTE to the anterior 2/3 pf the tongue?
Corda tympani (from CN VII - facial nerve)
31
65 y.o. man with vision problems, exam shows small yellow lesions clustered around the macula and scotomas
Macular degeneration
32
Occlusion of the ACA (anterior cerebral artery) would lead to problems with what parts of the body?
legs
33
What arteries make up the circle of willis?
34
What feature of the capillaries in the brain prevents drugs from freely crossing the BBB?
Tight junctions btw the capillary endothelial cells
35
the CNS originates from _______________ & the PNS originates from \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
CNS --\> from neuroectoderm
PNS --\> from Neural crest cells
36
What is the Nissl substance?
the RER in neurons
37
when an axon is injured and degenerates distally
Wallerian degeneration
38
Hypothalamus structures and functions
Supraoptic nucleus --\> makes ADH
Paraventricular nucleus --\> makes Oxytocin
Lateral hypothalamus --\> hunger (Leptin inhibits)
Ventromedial hypothalamus --\> satiety (Leptin increases)
Anterior hypothalamus --\> cooling, parAsympathetic
Posterior hypothalamus --\> heating, sympathetic
Suprechiasmiatic nucleus --\> circadian rhythm (sleep)
39
Occlusion of which artery would cause Broca's or Wernicke's aphasia?
MCA (probably the LEFT MCA since most people are Left dominant)
40
Speech that is fluent and words that are well articulated but it is meaningless "word salad", patient cannot understand you
Wernike's aphasia
41
neuromuscular disease (ataxia, myopathy, decrs sensation) & hemolytic anemia indicate a deficiency of \_\_\_\_\_\_\_\_\_\_\_
VITAMIN E
can happen in pts with Cystic Fibrosis due to malabsorption of fat soluble vitamins
42
a common feature of temporal arteritis (in \> 50% of people with the dz)
Polymyalgia rheumatica (fever, neck, torso, pelvic & shoulder girdle pain and weight loss)
43
an old ischemic infarct of the brain will appear like a cystic space and will be lined by what kind of cells?
Astrocytes --\> ischemic neurons undergo irreversible damage (become "red neurons") and die, then macrophages move in and eventually the necrotic material is resorbed and a cystic cavity forms --\> around the cavity Astrocytes proliferate (GLIOSIS)
44
What is usually the 1st symptom of alcohol withdrawal?
Tremulousness ("the shakes")
45
a boy with significant kyphoscoliosis and high plantar arches, his brother had a neurologic disorder and dies of heart failure at a young age, what does the boy have?
Friedreich Ataxia
- autosomal recessive, Frataxin gene mutation, trinucleotide repeat expansion
- gait ataxia
- dorsal column degeneration
- kyphoscoliosis & foot abnormalities
- Hypertrophic Cardiomyopathy
- Diabetes (in 10%)
46
Most common complication of a subarachnoid hemorrhage (happens in \> 50%)
secondary **vasospasm** around the ruptured aneurysm (leads to ischemia )
- can prevent with Nimodipine
47
triad of tinnitus, vertigo and sensorineural hearing loss in the affected ear
Meniere's disease
- increased volume of endolymph in the inner ear
48
What is the most common site of a Subarachnoid hemorrhage (saccular berry aneurysm rupture)?
Circle of Willis -- Anterior Communicating Artery
- associted with ADPKD and Ehlers Danlos
- artery doesn't develop a media layer --\> is weakend
49
man with lung cancer develops weakness getting up from a chair and fixing his hair--\> he most likley has antibodies to __________________ \_\_\_\_\_\_\_\_\_\_
presynaptic calcium channels
- ha has Lambert Eaton syndrome (like Myastenia gravis but assoc with cancer and gets better with activity)
50
what patients have a increased chance of developing Alzheimer's by age 40?
Down Syndrome patients
- gene for APP is on chromosome 21
51
Histologic & Gross findings in Alzheimer's dz
- extracellular senile plaques of **AB Amyloid **
- intracellular neurofibrillary tangles of phosphorylated **tau protein**
- grossly --\> widespread cortical atrophy , narrow gyri & wide sulci, dilation of the ventricles (hydorcephalus ex vacuo)
- decreased Ach levels in the hippocampus & nucleua basalis (b/c choline acetyltransferase decreased)
52
- slow- onset dementia
- no focal neurologic deficits
- APOE 4 allele is assoc with incrs risk
- AB amyloid plaques and tau tangles
Alzheimers dz
53
2nd most common cause of dementia
Vascular dementia
- due to HTN, atherosclerosis, vasculitis
54
- degeneration of the frontal and temporal cortex
- round aggregates of TAU protein (Pick bodies) in the neurons
- behavior and language changes early on
Pick disease (frontotemporal dementia)
55
- loss of dopaminergic neurons in the substantia nigra pars compacta
- loss of dopamine --\> can't initiate movement --\> shuffling gait, frozen face, tremor, bradykinesia
Parkinson's disease
- Tremor at rest
- Rigidity
- Akinesia/ bradykinesia
- Postural instability / shuffling gait
--the dementia should set in LATE in the dz ((if early on --\> it's Lewy Body dementia)
56
Histologic findings of Parkinson's
- round, eosinophilis inclusions ("Lewy bodies") in the affected neurons
- made of alpha- synuclein
57
- loss of GABA neurons in the caudate nucleus
- autosomal dominant , trinucleotide repeats of \_\_\_\_\_\_\_?
- further expansion of repeats during \_\_\_\_\_\_\_leads to Anticipation
- Huntington's dz
- CAG repeats
- further expansion during spermatogenesis causes anticipation
58
- urinary incontinence, gait instability, dementia
- increased CSF causes dilated ventricles and streches the corona radiata causing the symptoms
"wet, wobbly, & wacky"
- Normal Pressure Hydrocephalus
- LP can relieve symptoms
59
- PrPc (alpha helix) is converted to PrPsc (Beta sheet)
- becomes resistant to proteases
- rapidly progressive dementia , ataxia, startle myoclonus
Spongiform encephalopathy (ie: Creutzfeldt Jakob)
- prion disease
60
what are the 3 most common sources of brain metastases?
1- Lung
2- Breast
3- Kidney
--mets are usually multiple and at the gray/white junction \*\*
61
primary brain tumors are usually SUPRAtentorial in __________ and INFRAtentorial in \_\_\_\_\_\_\_\_\_
Adults , kids
62
most common malig brain tumor in adults
Glioblastoma Multiforme
- crosses the corpus callosum ('butterfly pattern")
- GFAP +
- poor prognosis
63
most common BENIGN CNS tumor of adults
Meningioma
- more in females
- tumor of the arachnoid cells
- psammona bodies may be present
64
benign tumor at the cerebellopontine angle that presents w/ hearing loss, tinnitus, tumor cells will be S-100 +
Schwannoma
((if bilateral --\> think NF-2))
65
- malignant tumor , presents w/ seizures
- calcified tumor in white matter of frontal lobe
- fried egg appearace
Oligodendroglioma
66
most common BENIGN CNS tumor in kids
**Pilocytic Astrocytoma**
- usually in cerebellum
- cystic lesion w/ nodular mass
- Rosenthal fibers
- GFAP +
67
- malignant CNS tumor in children
- derived from neuroectoderm
- small, round blue cells & Homer-Wright rosetts
- always in cerebellum
Medulloblastoma
68
incomplete closure of the neural tube at week ______ will result in neural tube defects
week 4
69
increased ________________ in maternal bld and amniotic fluid indicates a neural tube defect
AFP (alpha fetoprotein)
70
most common cause of hydorcephalus in newborns
Congenital aqueduct stenosis
71
What is shown in the photo?
Dandy-Walker Malformation
- failure of cerebellar vermis to develop
- huge, dilated 4th ventricle and no cerebellum
72
cystic degeneration at C8-T1
- loss of P&T in upper extremeties , spares dorsal columns
- due to involvement of ant white commisures & spinothalamic tract
Syringomyelia
73
congental herniation of the cerebellar tonsils thru the formamen magnum
Arnold- Chiari Malformation Type 2
74
- viral destruction of the anterior motor horns
- fecal-oral spread
- LMN signs
POLIO
75
autosomal recessive degeneration of the anterior motor horns
- "floppy baby" at birth
Werdnig -Hoffman
76
atrophy and weakness of the hands is an early sign of \_\_\_\_\_\_\_\_\_\_
ALS
- will get both UMN & LMN signs eventually
77
- tract that carries Pain & Temp from the body
- cell body in DRG --\> immed crosses in Ant white commisure --\> ascends to thalamus
Spinothalamic tract
78
tract that carries fine touch, vibration, pressure, & proprioception
- cell body in DRG --\> crosses in medulla , ascends via medial lemniscus to thalamus
Dorsal Columns
79
tract that carries voluntary movement from cortex to body
- pryamidal neurons in cortex descend, cross over in medullary pyramids --\> synapse on anterior motor horn cells (UMN) --\> then travels to LMN on muscle cells
Lateral Corticospinal tract (Pryamidal)
80
inflammation of the leptomeninges (pia & arachnoid) , can be due to bacterial, viral or fungal infection
Meningitis
- most common causes in neonates: Listeria, E.coli & GBS ("LEG")
81
do diagnose Meningitis, do an LP by placing the needle between ____ & \_\_\_\_
L4 & L5 (level of the Iliac crests)
-spinal cord ends at L2 in adults
82
viral meningitis in children
coxsackievirus
- fecal-oral
- CSF will have lymphocytes with normal glucose
83
CSF findings inbacterial meningitis
neutrophils w/ decreased glucose
84
CSF findings in Fungal meningitis
lymphocytes and decreased glucose
85
most strokes are \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**ischemic (85%) --\> ischemia that lasts longer than 24 hours is a stroke **
can be caused by:
- Thrombus --- pale infarct
- Emboli -- hemorrhagic infarct
- Lacunar strokes -- 2nd to hyaline arteriolosclerosis
86
ischemic stroke results in ___________ necrosis
liquefactive necrosis
87
the earliest change after an ischemic stroke is the presence of \_\_\_\_\_\_\_\_\_\_\_\_\_\_
RED NEURONS (12 hrs after infarct)
88
rupture of a **Charcot- Bouchard microaneurysm** will cause a ____________________ hemorrhage
Intracerebral hemorrhage --\> bleeding into the parenchyma
- these are a result of HTN
- lenticulostriate arteries in the basal ganglia are the most common sites
89
LP shows xanthochromia
Subararchnoid hemorrhage
- yellow due to the breakdown of bilirubin
90
blood btw dura and skull, lens shaped clot, lucid interval then LOC
EPIDURAL HEMATOMA
-due to rupture of the Middle meningeal artery
91
blood btw dura & arachnoid , due to tearing of bridging veins, crescent shaped lesion on CT
SUBDURAL HEMATOMA
92
uncal herniation (displacemnet of the temporal lobe uncus under the tentorium cerebelli) causes compression of CN \_\_\_\_\_\_
CN III
- eye moves down & out
- dilated pupil
93
Name the types of herniations
1= Uncal herniation
2= Central (transtentorial)
3= Cingulate (subfalcine)
4= Transcalvarial
5= Upward (upward cerebellar or upward transtentorial)
6= Tonsillar (downward cerebellar)
94
galactocerebroside accumulates in macrophages in this autosomal recessive dz
Krabbe's dz
- deficicency of galactocerebroside beta-galactosidase
95
impaired addition of Coenzyme A to long chain FA's
Adrenoleukodystrophy
96
Diagnosis of MS is made by:
- LP and a T2 weighted MRI
- LP will show lymphocytes, immunoglobulins w/ **oligoclonal IgG bands **
97
Subacute sclerosing panencephalitis is due to persistant _________ infection
MEASLES
98
Central pontine myelinolysis is due to
rapid IV correction of hyponatremia
- clinically presents as "locked in syndrome"
- focal demyelination of the pons
99
an ACA infarct will affect what part of the body? and an MCA occlusion will affect what parts?
ACA --- legs
MCA -- upper extremeties, face (including Broca's and Wernicke's areas)
100
spatial neglect syndrome (agnosia of the entire left side)
lesion of the right parietal lobe
101
affects 1 area of brain, preceded by aura, can be simple or complex
Partial seizures
- Simple Partial = no LOC
- Complex Partial = impaired consciousness
102
nucleus of the thalamus that gets sensory from the body
VPL
103
nucleus of the thalamus that gets sensory from the face
VPM
104
Lateral geniculate nucleus gets input from CN _____ to relay \_\_\_\_\_\_
CN II to relay vision input
105
**Medial geniculate** nucleus gathers input from olives & inferior colliculus to relay _______ info
hearing
106
lesion at the cerebellar vermis causes \_\_\_\_\_\_
truncal ataxia & dysarthria
107
damage to PPRF causes\_\_\_\_\_\_\_\_
damage to frontal eye fields causes \_\_\_\_\_\_\_\_\_\_
PPRF ---- eyes look away from lesion side
FEF --- eyes to toward lesion side
108
PICA infarct causes .....
**Lateral Medullary (Wallenberg) syndrome **
- vertigo, nystagmus, voimiting
- decrs P&T to limbs and face
- dysphagia, hoarseness
- IPSI Horner's syndrome
- Ataxia
109
PCA infarct at the occipital lobe causes \_\_\_\_\_\_\_
contralateral hemianopsia w/ macular sparing
110
Hemisection of the spinal cord (ie: after getting stabbed in the back) will cause \_\_\_\_\_\_\_\_\_\_
**Brown -Sequard Syndrome**
- IPSI UMN signs below the lesion
- IPSI loss of fine touch, vib, prop.. below lesion
- CONTRA P&T loss below lesion
- IPSI loss of ALL sensation at the level of the lesion
- LMN signs at the level of lesion
\*\* and if above T1 -- will also have Horner's syndrome
111
CN V exits the skul via what foramen??
V1 -**S**uperior Orbital Fissure
V2- **R**otundum
V3- **O**vale
"Standing Room Only"
112
abnormal Rinne (BC \>AC) and Weber localizes to affected ear
Conductive hearing loss
113
Sensorineural hearing loss
normal Rinne test and Weber localizes to the normal ear
114
feared side effect of Buproprion (antidepressant and smoking cessation drug)
Seizures! (esp in pt's with bulimia)
115
woman with bipolar and new onset seizures, what drug can help both of her conditions?
**Valproic acid **
- anticonvulsant and a mood stabilizer
- increases GABA in the CNS
- Carbamazepine is also both a mood stabilizer and an anticonvulsant \*\*
116
mechanism of Dantrolene
blocks Ryanodine receptors and prevents Ca+ release into the cyoplasm of skeletal muscle
117
man working in his yard suddenly develops flushed skin, dry mouth, dilated pupils--\> what did he get in to and what can reverse it?
Jimson weed poisoning ("gardener's mydriasis") --belladonna alkaloid that produces strong anticholinergic symptoms
- similar to Atropine overdose (hot as a hare, dry as a bone, mad as a hatter...)
* - antagonize by increasing Ach in the synaptic cleft (ex: Physostigmine) *
118
man with long standing diabetes who has recent diplopia, right eye is fixed down and out but PERRLA---\> what happened to the nerve?
Diabetic neuropathy causes ISCHEMIC CN III Neuropathy...
- the somatic motor function is lost but the parasympathetics are fine b/c they have different blood supply
- \*\*if the nerve was being compressed, however, the eye would be 'down & out' and the pupils would not be reacting to light
119
Pramipexole, Ropinerole, Bromocriptine & Pergolide are all \_\_\_\_\_\_\_\_\_\_\_
**Dopamine agonists **
-treat Parkinson's
((Bromocriptine also treats Prolactinomas ))
- Pramipexole & Ropinerole are non-ergot cmpds
- Bromocriptine & Pergolide are ergot cmpds
120
Which part of Wernicke-Korsakoff is permanent?
memory loss and confabulation (Korsakoff's psychosis)
121
What are the treatment options for Alzheimer's?
1- Cholinesterase inhibitors
2- Antioxidants (vit E)
3- NMDA receptor antagonists (memantine)
122
endoneural inflammatory infiltrate after a viral illness
Guillain - Barre
- ascending weakness / paraysis
- after vaccination, allergic rxn or illness (campylobacter infection)
123
What is 1st line treatment for Glaucoma?
Prostaglandins (ie: Latanoprost)
- incrs the outflow of aq. humor
- cause iris to become brown
(Other treatments include Epinephrine, TImolol, Acetazolamide -- to decrs the production of aq humor -- and cholinomimetics like pilocarpine to incrs the outflow)
124
Morphine, Fentanyl, Heroin, Codeine are all \_\_\_\_\_\_\_\_
**Opioids** -- most act at the opiod mu receptor (G-protein receptor)
- decrease synaptic transmission (open K+, close Ca+ channels)
- Toxicity = pinpoint pupils, resp depression\*, constipation -- treat overdose with NALOXONE!!
\*note: Tramadol is also an opioid agonist (weakly) and also incrs NE & serotonin -- treats Pain
125
1st line for Tonic Clonic seizures (grand mal)
Phenytoin, Carbamazepine or Valproic acid
- all increase Na+ channel INACTIVAION
- Valproic acid also increases GABA
126
1st line therapy for a Simple Partial seizure
**carbamazepine **
- incrs _Na+_ channel INACTIVATION
- also 1st line for Trigeminal neuralgia
127
1st line therapy for a Partial Complex seizure
Carbamazepine
128
What is the mechanism of the drug used to treat Absence seizures?
Ethosuxamide -- blocks thalamic Ca+ channels
129
What drug is used to PREVENT ***status epilepticus*** and what drug is used in the acute setting??
Prophylaxis --\> Phenytoin (Na+ channel INactivation)
Acute treatment --\> Diazepam or Lorazepam (incrs GABA)
130
1st line therapy for pregnant women & children with seizures
Phenobarbital (incrs GABA)
131
Most serious side effects of anti-epileptic drugs
**-Fulminant hepatitis**
**- Bone marrow suppression **
some others:
Carbamazepine --\> agranulocytosis, anemia, SJS, teratogen...
Phenytoin --\> gingival hyperplasia, Lupus like syndrome, teratogen
Valproic acid --\> liver toxicity , teratogen
132
Treat overdoses of ________ with Flumazenil
**Benzodiazepines** (generally end in "-lam , -pam"..)
-benzo's increase GABA by increasing the **frequency** of Cl- channel opening
(as opposed to Barbs which incrs GABA by increasing the duration of Cl- channel opening)
133
which cause LESS respiratory depression, barbiturates or benzodiazepines?
Benzodiazepines
134
a General anesthetic is faster acting if it is \_\_\_\_\_\_\_\_\_
- low solubility in blood (gets 'pushed' into tissues) = fast induction
- low Minimun alveolar concentration (MAC)
- high lipid solubility (high potency)
135
_barbiturates (like Thiopental)_ have short acting times as IV anesthetics b/c they rapidly shift from the brain to \_\_\_\_\_\_\_\_\_\_\_
skeletal muscle & fat
136
Why do you need to use **more** local anesthetic in infected tissue compared to healthy tissue??
infected tissue is acidic --\> alkaline anesthetics are charged and cannot penetrate easily
137
What is the order that the local anesthetics (lidocaine, procaine, cocaine...) affect nerve fibers (from 1st to last)?
Small myelinated fibers (beta) \> small (a delta) unmyelinated \> large myelinated \> large unmyelinated
138
Depolarizing neuromuscular blocker -- can cause hypercalcemia & -kalemia and malignant hyperthermia
SUCCINYLCHOLINE
(the curare derivatives are non-depolarizing and can be reversed with AchE inhibitors)
139
fairly new anticonvulsants that are used for treating _refractory partial seizures_ (not responding to other meds)
- Lamotrigine
- Tiagabine
- Topiramate
- Vigabatrin
- Gabapentin
\*\*BEWARE OF SKIN RASH
140
1st line treatment for symptoms of alcohol withdrawal?
Benzodiazepines
-Long acting Diazepam or Chlordiazepoxide are the first line
141
Medications used to abort a migraine headache have what effect at receptors?
**stimulate the post-synaptic Serotonin receptor **
-Triptans are serotoin 5HT 1B /1D agonists that inhbit the release of vasoactive peptides (like substance P), promote vasoconstriction, & block pain pathways
142
antidepressant that does NOT have sexual side effects
**Bupropion **
- good antidepressant, no sexual effects
- also helps treat nicotine dependence
143
Common drugs that can cause **Serotonin Syndrome** (clonus, rigidity, hyperthermia, tachycardia, tremor, sweating, agitation, mydriasis, diarrhea...)
- SSRI's, SNRI's, MAOIs, TCA's
- Tramadol
- Ondansetron
- Linezolid (an ABX)
- Triptans
144
TCA overdose cause of death
- arrythmias, refractory hypotension
- inhibition of the fast Na+ channels in the heart is to blame
145
What is the antidote / treatment for Serotinin Syndrome?
Cyproheptadine
- antihistamine w/ anti-serotonin properties
146
Main side effects of Scopolamine (antimuscarinic drug for motion sickness)
Antimuscarinic -- so you will have signs of decrs Ach/ parasympathetic activity
**- blurry vision**
**-dry mouth **
**- palpitations**
**-urinary retention & constipation **
147
P450 INDUCERS
- Barbiturates
- St John's Wart
- Phenytoin
- Rifampin
- Griseofulvin
- Carbamazepine
- Chronic alcohol use
"Barb Steals Phen-phen and Refuses Greasy CArbs CHronically"
148
Almost all volitile (inhaled) anesthetics increase blood flow to the \_\_\_\_\_\_\_\_\_\_
**brain**
- this is NOT a good thing though b/c it increases ICP
- inhalation anesthetics also decrs resp rate and cardiac rate & decrs GFR
149
Side effects of PHENYTOIN
- gingival hyperplasia
- generalized lymphadenopathy ("pseudolymphoma")
- hisutism & coarsening of the facial features, acne
150
Which antidepressants are most likley to cause urinary retention and other antimuscarinic SE's?
TCA's
- they act at several different receptors and have many side effects
151
Preferred treatment for people with combined Absence and Tonic-Clonic seizures
Valproic acid (Valproate)
152
Pt on an antidepressant, ate at an Italian restaurant and developed severe HTN, tachycardia...
Hypertensive crisis
-man was on MAOI and ate tyramine containing foods (wine, cheese...)
153
Thiopental (and other barbiturates) has a short period of action b/c it \_\_\_
rapidly redistributes from the brain to muscle and fat
154
Male with ADPKD has severe headache --\> admitted to hospital --\> several days later he complains of right sided weakness.... what drug could have been used to prevent the sequalae that occurred?
This pt had a Subarachnoid bleed (predisposed to berry aneurysm's due to ADPKD)
- he then had a secondary VASOSPASM which could have been prevented with a Calcium channel blocker (Nimodipiine\*\*)
155
Used as chemoprophylaxis for all contacts of a person sick with bacterial meningitis
RIFAMPIN
- must be given to all close contacts within 2 weeks
156
