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NURS216A > Neuro > Flashcards

Neuro Flashcards

1
Q

Addictive Personalities have decreased ____

A

Activity in the ventromedial prefrontal cortex

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2
Q

Hypothyroidism

A

Primary: destruction of the thyroid gland

Secondary: Hypothalamus or anterior pituitary gland

SS: tired, sleepy, low energy, mood alterations, difficult concentrating, decreased appetite, mimic depression or concussion.

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3
Q

Physiology of Thyroid Condition

A

Hypothalamus secretes TSH, TRH stimulates pituitary gland to release TSH, TSH acts on thyroid gland. Thyroid gland then releases t3 and t4. t4 is the inactive thyroid hormone. Calcitonin from parafollicular glands for bone building. t3 and t4 are from the follicular glands and influence metabolism

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4
Q

Treatment of hypothyroidism:

A

Levothroxine (Synthroid) - Synthetic form of T4

*hepatic metabolism CYP34A, highly PPB, excreted unchanged, drug interactions with antiseizure meds.

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5
Q

Sympathetic and Parasympathetic NS are

A

Outside of voluntary control

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6
Q

Ach exists as a NT in

A

Preganglionic PNS and SNS
Postganglionic in PNS
Somatic NS (binds to muscle receptors)
CNS

(peripheral and central NT)

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7
Q

Norepi exists as a NT in

A

(peripheral and central NT)
postganglionic in SNS
CNS NT
vital in adrenergic communication

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8
Q

COMT is the enzyme for

A

Catecholamines (epi and norepi)

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9
Q

MAO is the enzyme for

A

dopamine and serotonin

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10
Q

Cholinesterase is the enzyme for

A

Ach

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11
Q

NT’s that stimulate the SNS

A

catecholamines (epi and norepi)
Adrenergics
sympathomimetics

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12
Q

NTs the stimulate the PNS

A

cholinomimetics

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13
Q

Catecholamines stimulate the ____ nervous system

A

Sympathetic

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14
Q

Examples of catecholamines

A 
Epinephrine (a&b)
Norepinephrine (A&B)
Dobutamine (beta 1)
Dopamine (beta 1)
phenylephrine (alpha)
Ventolin (beta 2)
Serevent (beta 2)
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15
Q

Norepinephrine is more sensitive to ___ receptors

A

alpha

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16
Q

Cholinomimetics stimulate the ____ nervous system

A

Parasympathetic

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17
Q

Cholinomimetics in the PNS

A

stimulate acetylcholine
ex. mucomyst (increase secretions)
Pilocarpine (decrease intraocular pressure, in glaucoma)

SE (cholinergic effects)
hypotension, bradycardia, increased secretions, bladder spasms

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18
Q

Pilocarpine

A

Used for glaucoma to decrease intra ocular pressure.

  • eye drops
  • increases aqueous humour outflow.

SE: topical formulation, tearing, blurry vision, headache

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19
Q

Nicotine

A

affects cholinomimetic and adrenergic receptors.

Affects:
- Sexual arousal
-Decreased appetite, perception of pain, anxiety
-Increased glucose, 
-vasoconstriction/HR
-muscle contraction
BBB, highly addictive
*stimulates reward pathway.
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20
Q

Vaping

A

only research to be done was by food drug canada (for ingestion only)

  • aerosols inhaled are toxic.
  • Negative neuroplasticity.
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21
Q

Addiction

A

younger people start the more addicted they get, the brain learns to grow favouring addiction and addictive personality.

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22
Q

Addiction Treatment for Nicotine

A

Bupropion (zyban, wellbutrin)
- dopamine and norepi reuptake inhibitor.
SE: seizures, insomnia, headache , VS changes
*overstimulation of the brain

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23
Q

Indirect Adrenergic Agonists

A

Enhanced release of catecholamines

Meds:
Ephedrine (anti secretion med sudafed)
- enhanced focus, ability to perform, shakiness, nervousness.

Amphetamines: (Parkinsons drugs)
vasoconstriction, wakefullness, focus, elation, decreased appetite.

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24
Q

Clinical Amphetamines

A

treat ADHD: methylphenidate (ritaline, concerta)
SE weight loss, tachycardia, insomnia.

other uses: amphetamine, Methamp
- addictive street drug, performance enhancing.

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25
Q

Crystal Meth

A

highly addictive, rave drug

SE: dilated pupils, sweating, jerky movements, tachycardia, high BP, hyperthermia, hallucinations, panic attacks, aggressive behaviour, insomnia.

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26
Q

Alzheimer’s Disease

A

Neurodegenerative disease: loss of neurons and synapses, Ach containing cells, plaque buildup.
Risk factors include head injury, obesity, genetics, aging.

No cure: treatment focusses on increasing amount of Ach in synapses.

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27
Q

Acetylcholinesterase Inhibitors (cholinesterase blockers)

A

stop cholinesterase enzyme from breaking down Ach.
Meds:
Galantamine/Rivistigmine (dementia tx)

Neostigmine (no BBB, for mysthenia gravis)

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28
Q

Scopolamine

A

Anticholinergic (Ach block)
- used for N&V
Misuse can lead to dilated pupils, blurred vision, increased sensitivity to light, confusion, amnesia, sedation and unconsciousness.

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29
Q

Nicotinic Antagonists

A

Block Ach binding at nicotinic receptors (SNS, PNS, Skeletal muscle junctions)

Meds:
Vecuronium
Rocuronium
Pancuronium
Succinylcholine (short t1/2) *for short term paralyzation
Botox
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30
Q

Curare

A

Nicotinic Antagonist (anticholinergic)

Specificity to somatic NS
-Causes respiratory muscle paralysis

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31
Q

Why does alcohol give us the munchies

A

Alcohol increases Ca influx into AgRp neuronal cells. This causes hunger signaling. These cells are only present in hypothalamus.

32
Q

Norepinephrine

A

Excitatory

when High: paranoia, anxiety, stress

low: lethargy, low focus

33
Q

Dopamine

A

Excitatory - reward pathway and pleasure

High: anxiety, psychosis
low: depression, lethargy

34
Q

Serotonin

A

Inhibitory - calming mediator, balances mood

High: lethargy
low: anxiety, mood swings

35
Q

GABA

A

Inhibitory - increases Cl influx, decreased cell activity

high: lethargy, confusion, sedation, amnesia
low: anxiety, insomnia

36
Q

Glutamate

A

Excitory- NMDA receptor, memory, learning

High: focus, anxiety
low: low focus, poor retention

37
Q

Substance P

A

Excitory: resp for pain

38
Q

All CNS drugs have these cautions

A

cholinergic or sympathomimetic side effects

  • drug drug interactions
  • addiction
  • withdrawal
  • Dangerous with alcohol consumption
39
Q

Seizure Treatment Goal

A

to increase GABA, decrease neuronal excitability.

40
Q

Anxiety Treatment Goal

A

Increase GABA, increase serotonin

41
Q

Psychosis Treatment Goal

A

Decrease dopamine and get a better balance

42
Q

Seizure Meds

A

Benzodiazepines: -am
Diazepam, Clonazepam
-treatment of status epilepticus

Barbituates -barbital
Phenobarbital, pentobarbital

Anticonvulsants (decrease neuronal activity, delay depolarization, increase GABA)
Phenytoin, Carbamazepine, Valproic Acid

43
Q

Assisted Suicide Meds

A

Secobarbital at high doses, metoclopramide for NV

44
Q

Anxiety, Panic Attack Treatment

A

opens the Cl channel, more Cl in and calms the brain.

Benzodiazepines
1st line and fast acting:
Midazolam (versed), Lorazepam (ativan)

Long acting
-Diazepam (valium), Clonazepam (klonopin)

45
Q

Euthanasia Drugs

A

Benzos, propofol and rocuronium

46
Q

Benzodiazepine Abuse

A

Flunitrazepam (Rohypnol)
10x potency of valium
-intermediate acting, peak 2 hours, duration 4-6

Alprazolam (Xanax)
-used for recreational high.

47
Q

Chronic Pain Treatment

A

Moderate efficacy opioids prescribed.

Chronic pain changes the pain pathway, this often leads to complicated and difficult to treat pain. CBT is needed.

Meds:
Gabapentin (neurontin)
-increases GABA (calming), excreted unchanged, addiction

48
Q

Psychosis

A

Perceptive loss of reality
SS: hallucinations, delusions, lack of awareness and judgement, mood and affect alterations

Etiology: mental health illness, schizophrenia, bipolar disorder, severe depression. 
Drug side effects
Electrolyte imbalances
Sepsis in elderly
Overstimulation
49
Q

Hallucinations

A

Deficit of the sensory information pathway.

in sensory block stored images replace intel

Neuronal dysfunction (hyperactivity, pathway dysfunction and end organ failure (drug induced, pathology - tumor)

50
Q

Schizophrenia

A

Dysfunction of thoughts and language expression, chronic illness.
SS:
abnormal behaviours and movement
incomprehensible speech
invented words, disconnected words and thought processes, works
Alterations in function, hallucinations, delusions, paranoia, disorganized thought.
Mood alterations, agitated and unsettled. Withdrawn and apathetic.

*this is a pathway dysfunction

51
Q

Psychosis Tx

A

Neuroleptics:
Selective D2 dopamine receptor block in limbic system.
We want specificity to limbic system. high PPB, not addictive.

Extrapyrimidal side effects like Tardive dyskinesia calls for stopping treatment. (basal ganglia are being stimulated)

52
Q

Antipsychotic Drugs: D2 Antagonism

A

Chlorpromazine
Haldol
(these take 6-8 weeks to see an improvement)

5HT blockade, anticholinergic, sedation.
*urinary retention, dry mouth, sexual dysfunction
Neuroleptic Malignant Syndrome: hyperthermia, unstable BP, diaphoresis, incontinence.

weaning protocols in place to prevent delirium tremens (shakiness, muscle spasm, disordered thoughts)

53
Q

Withdrawal Symptoms

A 
Irritbility
insomnia
anxiety
tremors
N&V
Seizures
hallucinations
54
Q

Atypical Drugs for Psychosis

A

Olanzapine (zyprexa) (highly prescribed bc less sedation)
Quetiapine (seroquel)
Clozapine (clozaril)
Risperidone (risperdal)

These have minimal sedation, depot injections

55
Q

Positive symptomology

A

restlessness, insomnia

56
Q

Negative symptomology

A

depression, withdrawal, apathy, flat affect.

*sedation doesn’t add to these

57
Q

Adjunct Psychosis drugs

A

Lithium:
Decreases Na cellular influx = stabilizes mood.
decreased impulsivity and decreased mood swings.
*serum monitoring, pregnancy category D

58
Q

Depression Treatment Goals

A

increase serotonin, increase norepinephrine

59
Q

Parkinson’s Treatment Goals

A

Increase dopamine

-dopamine agonists

60
Q

Dementia/Alzheimers Treatment Goals

A

increase Ach

-choliniomimetics

61
Q

Parkinson’s Disease

A

accumulation of lewy bodies and destruction of dopamine neurons. only at 75% destruction do we start to see symptoms.
-inhibits impulse ability, muscles are rigid

Meds:
-Levodopa (synthetic dopamine),
Rotigotine (Neupro)

62
Q

Depression

A

SS:
loss of interest in activities
inability to experience pleasure, decreased concentrations, sleep alterations, appetite alterations, suicide ideation
*common misdiagnosis is hypothyroidism

*neurotransmitter dysfunction
Drug induced, could have contributing illness

63
Q

Depression Treatment

A 
1st line:
SSRIs
Fluvoextine (prosac)
Sertraline (Zoloft)
Paroxetine (paxil)
Citalopram (celexa)

2nd line:
SNRIs
Mirtazapine (remeron)
Buproprion (wellbutrin)

64
Q

Serotonin Syndrome

A

Agitation, hallucinations, tachycardia, BP changes, NV, diarrhea

A sudden surge of serotonin

65
Q

Conscious Sedation

A 
Drugs:
Ketamine (crosses BBB)
decreases CNS excitation
-decreased glutamate
Ca Channel blockade
Central analgesia
Doesn't affect GABA

Sensory blockade, amnesia, altered resps and VS.

66
Q

Anesthesia Goals

A
  1. unconsciousness
  2. Pain control
  3. Loss of reflexes (procedure dependant)
67
Q

General Anesthetic

A

unconsciousness:
Propofol IV, to keep unconscious.
Nitrous Oxide (used for induction of unconsciousness)

Analgesia:
Fentanyl (causes less itching than morphine

Muscle paralytics for loss of reflexes
- Rocuronium

68
Q

Propofol

A

Sedative hypnotic and GA
onset - 10-15 seconds
increases GABA
SE: no analgesia, resp depression, hypotension

69
Q

Rocuronium

A

Muscle relaxant and paralytic.

onset 1-3 minutes, duration 15-60 mins

70
Q

Local Anesthesia

A 
Sodium Channel blockers (no cellular depolarization)
Meds:
-pilocaine (longer duration)
-lidocaine
-buprivicaine (longer duration)
71
Q

Cocaine

A

BBB damage, alters the permeability of the BBB

72
Q

Nerve blocks

A

local anesthetic injected near the nerve or inferior to the root.

73
Q

Adjunct to local anesthetics

A

Epinephrine
-increased vasoconstriction, localized effect

Opioids:
pain relief.

74
Q

Epidural Anesthetic

A

cervical, thoracic, lumbar

Location ensured by no CSF return in needle.

75
Q

Ropivacaine

A

Selective drug for sensory fibers, not for motor. Used in labour and delivery

76
Q

Side effects of epidural

A

loss of sensation, hypotension, resp depression, catheter migration, site infection, hematoma.
Urinary retention, injury and CSF infiltration

77
Q

Spinal Intrathecal Anesthetic

A

Drug delivered directly into CSF
Blocks a band of nerves
always delivered below L2, avoids cord damage

NURS216A (15 decks)

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