Neuro Flashcards by Rachel Cloke

leading cause of neurological disability in young adults and in whom

MS, women

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clinical symptoms of MS

hand cramps, double vision, slurred speech, ataxia, depression, cog dysfunction, blurry vision

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Lhermittes phenomenon

tingling in extremities with neck flexion d/t cervical cord lesion in MS

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Internuclear ophthalmoplegia (INO)

lesion in brainstem, patient will have lack of adduction of one eye with nystagmus in the other eye (eyes don’t align)

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white matter lesions are present in which illness

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4 Core features of PD

Tremor, Rigidity, Akinesia/bradykinesia, Postural instability associated with flexed posture

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non-motor signs of PD

Constipation
sleep disorders
depression
olfactory impairment (happens early-10 yrs prior)
Dysphagia 
Autotomic dermatitis (late)
Orthostatic hypotension

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motor signs of PD

freezing
dyskinesia
micrographia (small handwriting)
shuffling gait
hypophonia (soft speech)

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micrographia

small cramped handwriting

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Bradykinesia

slowness of movement

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Hypophonia

soft speech

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DaTSCAN

measures dopamine in the brain

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PD is the loss or gain of what?

dopamine

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usual age onset of PD?

45-65 years old

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second most common neurodegenerative disorder?

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first most common neurodegenerative disorder?

Alzheimers

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what meds can induce parkinsonism?

Haldol, high doses of CCB, SSRIs

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Myersons sign

repetitive tapping over the bridge of the nose may cause blinking

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when is an MRI done in PD?

to rule out other causes of symptoms

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what symptoms indicate vascular parkinsonism?

isolated shuffling gait and step-wise progression of symptoms

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does PD have early difficulties with falls?

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Stages of PD

1- one side affected, no impairment
2-Both sides affected, no impairment

3- Both sides affected, mild posture and balances affected, still independent

4-Both sides affected, disabling instability, can’t live alone

5-Both sides affected, restricted to bed

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what are you at greater risk for with Carbidopa/levodopa?

long-term motor complications like dyskinesia

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what are you at greater risk for with Dopamine Agonists (Requip, Permax)?

impulse disorders (sex, gambling)

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Dopamine Agonists (Requip, Permax) side effects

hallucinations, delusions, nightmares, leg edema, daytime somnolence

Amantadine is added for problems with what symptom of PD

good for motor symptoms and dyskinesia

Dyskinesia vs bradykinesia

bradykinesia=slow movements | Dyskinesia=uncontrolled, involuntary movements

What 4 meds are mostly use in PD?

MAO inhibitors, Dopamine agonists and carbidopa/levodopa, amantadine

If PD patient has constipation, what meds should you assess?

anticholinergic (antihistamines, trycyclic antidepressants, CCB)

can MOI inhibitors be give alone or needed to be given with another med for PD?

either

MOI inhibitor examples for PD

Seligiline, Eldepryl

MAO inhibitor examples for PD

Dopamine agonist examples

Requip, Permax

Carbidopa/levodopa med doses

10/100, 25/100, 25/250

usual starting dose for Carbidopa/levodopa

1/2 tab-1 tab TID, can go up to 2 tabs QID

Before a referral to neuro, should you try a therapeutic trial before hand?

no because it can mask diagnostic findings

options for levodopa dyskinesia?

1. ) decrease levodopa dose and give more frequently and/or increase dopamine agonist 2. ) reduce dose of any MAO inhibitor 3. ) add amantadine

what are anticholinergic meds used for with PD

in younger patients with tremor. (Not used often)

off time vs wearing off in PD

off time are periods during the the day when the medication is not working well, causing worsening of Parkinsonian symptoms. wearing off may occur predictably and gradually. Need to change med regime

AD hallmark signs on MRI

- Amyloid plaques and neurofibrillary tangles (NFTs) - Oxidative stress - Sytsemic inflammation

typical screening test for AD

montreal cog assessment

medication classes for AD

Cholinesterase inhibitors, NMDA receptor antagonist

Cholinesterase inhibitors

used for AD; Rivastigmine (exelon) and Galantamine (Razadyne)

Rivastigmine (exelon) and Galantamine (Razadyne) are used for which illness and what drug class

AD; Cholinesterase inhibitors

Galantamine (Razadyne) what problem should you avoid this in? give with food or without food? side effects?

avoid if patient has hx of syncope; give with food; | side effects: GI, bronchonstriction, wt loss, anorexia

Rivastigmine (exelon) side effects

syncope, wt loss

NMDA receptor agonist medication

Memamantine (Namenda)

Memamantine (Namenda) side efects

steven johnson, wt gain, aggression, somnolence

AD typical age

>65

who is more at risk for AD?

first degree relative, depression, APOE42 gene, patients with cardiovascular risk factors

what meds are used with AD when patient has behavioral probs?

SSRIs

what meds should not be used with aggressive behaviors of AD?

anticonvulsant unless they have a hx of bipolar

what is an independent risk factor for delirium?

Dementia

Treatment of acute relapse of MS

IV methylprednisolone 1g IVx3-5 days, no oral steroid taper

AD stages

Stage 1-no changes Stage 2-Very mild- minor forgetting Stage 3-Mild-forgetting names, not retaining reading material, losing objects, can be diagnosed, cog changes seen in office Stage 4-moderate-cant preform complex tasks, reduced personal hx, can't remember recent occasions Stage 5-moderate severe-major gaps in memory, confused about location, date, need help choosing clothing Stage 6 and 7-dependent care

6 Cognitive domains of dementia

Complex attention, executive function, Learning and memory, language, perceptual motor, social cognition

executive function (one of the cognitive domains of dementia)

can't do multiple tasks, they put shoes in fridge

Perceptual motor (one of the cognitive domains of dementia)

visual issue-readings different, they can't interpret things

Social cognition (one of the cognitive domains of dementia)

react inappropriately in a social situation ex: funeral and laugh

Relapsing remitting MS

symptoms get worse then recover, found in early diagnoses, disease does not get worse

secondary progressive MS

you don't get symptoms that come and go like in RRM, symptoms just get gradually worse

primary progressive MS

no obvious relapsing, symptoms just get worse

primary progressive MS vs secondary progressive MS

primary progressive MS does not experience the relapsing remitting phase of MS like secondary progressive MS people did

Pseudo-Relapse in MS

something causes you to flare like getting a fever, infection, hot weather.

MS remission

you return to the previous phase before the relapse

Neuro Flashcards

(65 cards)