Neuro Lecture 4 Flashcards by Meg Dolohanty

What medicines do you use controlled substance contract for?

any controlled substance

ex- benzos, opioids, sedatives, stimulants

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what can you do to make sure people are following a controlled substance contract?

random drug screens (know metabolite list)

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If they break a controlled substance contract what can you do?

terminate services

2. offer rehab/ counseling

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what is the primary reasons for a controlled medication agreement?

Patient education

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What is a chronic inflammatory disorder of the CNS that is immune mediated?

Multiple sclerosis

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MS is damage caused by the _____ immune system.

innate

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Is MS auto-immune?

No, it is immune mediated

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What is the pathology of MS

Inflammation disrupts BBB

T-cells and macrophages cause damage around the blood vessel involved

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Is MS a white matter disease?

Not specifically, also affects grey matter

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What imaging should you use for MS

Brain MRI with contrast

allows you to see inflammatory lesions

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What will the lumbar puncture look like with a majority of MS patients?

oligocloncal bands of non-specific IgG

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What is the most common cause of inflammation of the optic nerve (optic neuritis)

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is cognitive impairment typically a white or grey matter issue

grey matter

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what are sign of MS

any neurologic sign

can be anywhere

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how do diagnose MS?

History

MRI may not show smaller lesions

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to be diagnosed with MS what must have happened

Basically, two or more attacks (demonstrated clinically or by MRI) disseminated in space and time

(ex- inability to use arm that got better then numbness in leg that then got better)

or one year of progressive symptoms and MRI show lesions disseminated by space

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Diagnosis for patients who have had only one (monofocal) attack, or two or more (multifocal) attacks simultaneously.

Clinically isolated syndrome (CIS) means there is a high risk of developing MS

will treat them like they have MS

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what are the 4 types of MS?

relapsing-remitting
progressive-relapsing
secondary - progressive
primary-progressive

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What does the lesion normally follow in MS?

the artery. Usually perpendicular to the ventricles (because they follow a blood vessel

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What does “benign MS” mean

Like relapsing remitting, but you return to baseline after every episode

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What type of MS starts out as relapsing-remitting but converts into a progressive form

secondary progressive MS

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what can help relieve acute symptoms of MS?

High-dose IV corticosteroids

Plasmapheresis may help some patients who don’t respond to steroid therapy

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what are MS disease modifying treatments?

Interferon β-1a,
Interferon β-1b
Glatiramer acetate

reduces relapses by about 1/3
doesn’t work as well with people who get continuously worse

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what are Natalizumab and mitoxantrone used for?

Second line agents for MS disease-modifying treatment.

Have severe side effects

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Is there any effect pharmacologic treatment for progressive MS?

What can help MS patients after an episode to get them back to a functioning level?

Neurorehabilitation

When is MS commonly diagnosed and in whom?

20-50 | more common in girl than women but equal once over 50

Is MS considered an inherited disorder?

No, but there are identifiable genes that make you more risk for developing it

Does MS affect life expectancy?

No, not significantly (only 5-10 years)

what is a prolonged, deep state of unconsciousness that lasts longer than 6 hours?

Coma

What causes a coma?

Dysfunction of the cortex or the reticular activating system

what are the three components of the Glasgow Coma Scale?

Eye Verbal Motor

how many points for eye

1-4

how many point for verbal?

1-5

How many points are for motor?

1-6

What's the highest score for glasgow coma scale?

what is considered a severe brain injury on GCW?

3-8

What's a normal range for GCS?

13-15

How do you record the GCS?

Total score then score for each and time

Causes of coma?

Intoxication OD, Misdose Stroke/ herniation of brain head trauma, brain loss

what's the most common cause of coma?

Drugs

Is hypothermia used to treat a coma or is it a cause?

Both

How do you diagnose coma?

Rule out locked-in state (can move eyes but nothing else) | Rule out psychogenic unresponsiveness (caloric stimulation)

What tests should you get one someone with a coma?

Toxin screen glucose, BMP brain imaging

What do all coma patients get put on for seizure prophylaxis?

levitoraceatam

Posture where patient is flexed. Cortex is usually involved

Decorticate posturing

Posture where patient is extended. Usually brainstem is cause of coma

Decerebrate (extensor) posturing

If pupils are equal and reactive is the person probably in a coma?

If a person have pinpoint pupils that are reactive what is the likely cause?

Opioid OD

If both pupils are dilated and don't react what is probably the case?

Not really alive | coudl really ahve hypothermia, severe hypoxia, stimulant OD, too much cocaine

If one eye is dilated and unreactive with coma where is it probably

Ipsilateral side

What is status epilepticus w/o physical signs

Subclinical status epilepticus

What imaging tests should you do for coma?

MRI/ CT EEG battery of neuro tests

why do you put coma patients in a hypothermic state.

saves brain tissue, less damage

What can tetracycline and minocycline cause neurologically?

Pseudotumor cerebri (increased ICP)

what can lidocaine cause?

Garrulousness (talking your ear off) psychosis used in cardio

What is amiodarone used for and what is the common main problem of it.

anti arrythmic agent | tremor is the main problem

what is a big problem calcium channel blocker cause?

tardive dykinesia (over time, usually around mouth)

What can statins cause?

muscle pain and weakness

What can dopamin-receptor blockers cause (enti-emetics)

Parkinsonian syndrome

Lots of Tums or pills high in magnesium and aluminium what can they cause?

Imbalanced electrolytes

what can salicylates (aspirin) cause?

seizures

what can NSAIDs cause?

medication overuse headaches

what is nicotine?

a powerful stimulant

What do oral hormone replacements cause?

Stroke

What does caffeine decrease?

blood flow in the brain | can cause enhanced physiologic tremor

what is the most common reason for seeking medical care?

pain

what are 4 types of pain

nociceptive pain (visceral, somatic) neuropathic pain psychogenic pain idiopathic pain

pain that is is often poorly localized but intense. Pain is found in ligaments, joints, blood vessels. Opiates are often used for this type pain

deep somatic pain

pain is relatively well-defined and easy to locate

superficial

what type pain indicates that the CNS and PNS and functioning correctly

nociceptive pain

where does lung pain refer?

Shoulder

Where does testicular pain refer?

Up towards kidneys

pain due to the PNS malfunctioning due to injury or disease.

Neuropathic pain

3 pain cuases of neuropathic pain

diabetic peripheral neuropathy postherpetic neuraliga cancer

Press lightly on skin and it feels a lot harder (over sensitive to feelings in that area)

hyperalgesia

Where connections aren't made correctly. (ex- do a needle prick and they feel pain)

Allodynia

pain that is more commonly caused by grief, social rejection, emotions often found in headache, abdominal pain, muscle aches, lower back.

psychogenic pain

type of pain where no physical or psychosocial cause is identified

idiopathic pain

what type pain is fibromyalgia?

idiopathic pain

pain that extends beyond the period of healing as the result of an abnormality of the central nervous system (CNS not working correctly)

chronic pain

is chronic pain nociceptive pain?

No, because CNS isn't working correctly

is the goal of therapy for chronic pain to get rid of the pain?

No goal is is to build a life that you can enjoy and be proud of.

what type pain are opiate analgesics effective for?

Acute Sharp Moderate/severe Visceral/deep-somatic pain

what 2 conditions are there no indication for the benefit of long term opiate treatment?

chronic headache | osteoarthritis

what is a NSAID drug that can be given for pain exacerbations

Ketorolac IM (give in the gluteus) it will burn (acidic), give it slow for an 8/10 or more

when can't you ketorolac?

When they are bleeding (ex- on period)

what can you give when you suspect muscle spasm is the pain?

muscle relaxants

what are some seadating tricyclic antidepressants?

amitriptyline, nortriptyline, (& trazodone- SARI)

What are some SNRIs that are good with depression and daytime pain?

Duloxetine, venlafaxine, desvenlafaxine

Name alpha adrenegeric agonists that are used so signal of pain doesn't go into brain. Believed to stimulate inhibitory interneurons, useful for pain and muscle spasm.

Clonidine, tizanidine

what drugs helps with the "gateway" theory? overload the pain stimuli

Capsaicin (don't give with zoster) | menthol

what are some other topical agents for pain?

Lidocaine | Ibuprofen, gabapentin

what are some injected local anesthetics for pain

lidocaine | marcaine

Stimulates nerves under skin

TENS (Transcutaneous electrical neurostimulation) | interferential current therapy (IFC)

who normally develop an opiate addiction?

history of substance use disorder psychiatric comorbidity hx of pre-adolescent sexual abuse

A physiological state characterized by a decrease in the effects of a drug (e.g., analgæsia, nausea or sedation) with chronic administration. Need to increase dose for same effect

Tolerance (anyone on opiates will experience this)

Physiological adaptation to the presence of a medication. The development of withdrawal symptoms when it is discontinued, when the dose is reduced abruptly or when an antagonist is administered.

Dependence

Compulsive use of the medication for nonmedical reasons. Involves dysfnctional behaviors

Addiction

Involves pain-relief seeking behavior. Iatrogenic condition, best treated by education

Pseudo-addiction

who is pseudo-addiction the fault of?

The provider

A chronic pain condition most often affecting one of the extremities (arm, leg, hands, or feet)

complex regional pain syndrome

Type of CRPS that Usually occurs after an injury or trauma to that limb (usually has nerve damage)

CRPS-I

Type of CRPS that can occur w/ no injury

CRPS-II

who does CRPS not affect

children under 5, rarely under 10

who does CRPS typically affect?

``` Women, mean age is 52 smoke tobacco (68% of patient do) ```

what are some symptoms of CRPS?

``` disproportionate to inciting event may involve whole extremity edema (neurogenic) elevation in skin temp (good sign, easier to treat) abnormal sweating pattern ```

what type osteoporosis is common w/ CRPS

patchy osteoporosis

how do you diagnose CRPS?

history and physical exam basically rule out a bunch of other things EMG (show difference b/w type I and II)

Some patients with CRPS have ___________ mediated pain that can be decreased by a nerve block.

sympathetic

is amputation of a limb effective at controlling CRPS?

Not really, only helps 50%