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Flashcards in Neuro Lecture 4 Deck (111):
1

What medicines do you use controlled substance contract for?

any controlled substance
(ex- benzos, opioids, sedatives, stimulants)

2

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

random drug screens (know metabolite list)

3

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

1. terminate services
2. offer rehab/ counseling

4

what is the primary reasons for a controlled medication agreement?

Patient education

5

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

Multiple sclerosis

6

MS is damage caused by the _____ immune system.

innate

7

Is MS auto-immune?

No, it is immune mediated

8

What is the pathology of MS

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

9

Is MS a white matter disease?

Not specifically, also affects grey matter

10

What imaging should you use for MS

Brain MRI with contrast
(allows you to see inflammatory lesions)

11

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

oligocloncal bands of non-specific IgG

12

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

MS

13

is cognitive impairment typically a white or grey matter issue

grey matter

14

what are sign of MS

any neurologic sign
can be anywhere

15

how do diagnose MS?

History
MRI may not show smaller lesions

16

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

17

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

18

what are the 4 types of MS?

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

19

What does the lesion normally follow in MS?

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

20

What does "benign MS" mean

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

21

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

secondary progressive MS

22

what can help relieve acute symptoms of MS?

High-dose IV corticosteroids
Plasmapheresis may help some patients who don't respond to steroid therapy

23

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

24

what are Natalizumab and mitoxantrone used for?

Second line agents for MS disease-modifying treatment.
Have severe side effects

25

Is there any effect pharmacologic treatment for progressive MS?

No

26

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

Neurorehabilitation

27

When is MS commonly diagnosed and in whom?

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

28

Is MS considered an inherited disorder?

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

29

Does MS affect life expectancy?

No, not significantly (only 5-10 years)

30

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

Coma

31

What causes a coma?

Dysfunction of the cortex or the reticular activating system

32

what are the three components of the Glasgow Coma Scale?

Eye
Verbal
Motor

33

how many points for eye

1-4

34

how many point for verbal?

1-5

35

How many points are for motor?

1-6

36

What's the highest score for glasgow coma scale?

15

37

what is considered a severe brain injury on GCW?

3-8

38

What's a normal range for GCS?

13-15

39

How do you record the GCS?

Total score then score for each and time

40

Causes of coma?

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

41

what's the most common cause of coma?

Drugs

42

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

Both

43

How do you diagnose coma?

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

44

What tests should you get one someone with a coma?

Toxin screen
glucose, BMP
brain imaging

45

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

levitoraceatam

46

Posture where patient is flexed. Cortex is usually involved

Decorticate posturing

47

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

Decerebrate (extensor) posturing

48

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

No

49

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

Opioid OD

50

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

51

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

Ipsilateral side

52

What is status epilepticus w/o physical signs

Subclinical status epilepticus

53

What imaging tests should you do for coma?

MRI/ CT
EEG
battery of neuro tests

54

why do you put coma patients in a hypothermic state.

saves brain tissue, less damage

55

What can tetracycline and minocycline cause neurologically?

Pseudotumor cerebri (increased ICP)

56

what can lidocaine cause?

Garrulousness (talking your ear off)
psychosis
used in cardio

57

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

anti arrythmic agent
tremor is the main problem

58

what is a big problem calcium channel blocker cause?

tardive dykinesia (over time, usually around mouth)

59

What can statins cause?

muscle pain and weakness

60

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

Parkinsonian syndrome

61

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

Imbalanced electrolytes

62

what can salicylates (aspirin) cause?

seizures

63

what can NSAIDs cause?

medication overuse headaches

64

what is nicotine?

a powerful stimulant

65

What do oral hormone replacements cause?

Stroke

66

What does caffeine decrease?

blood flow in the brain
can cause enhanced physiologic tremor

67

what is the most common reason for seeking medical care?

pain

68

what are 4 types of pain

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

69

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

70

pain is relatively well-defined and easy to locate

superficial

71

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

nociceptive pain

72

where does lung pain refer?

Shoulder

73

Where does testicular pain refer?

Up towards kidneys

74

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

Neuropathic pain

75

3 pain cuases of neuropathic pain

diabetic peripheral neuropathy
postherpetic neuraliga
cancer

76

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

hyperalgesia

77

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

Allodynia

78

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

psychogenic pain

79

type of pain where no physical or psychosocial cause is identified

idiopathic pain

80

what type pain is fibromyalgia?

idiopathic pain

81

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

82

is chronic pain nociceptive pain?

No, because CNS isn't working correctly

83

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.

84

what type pain are opiate analgesics effective for?

Acute
Sharp
Moderate/severe
Visceral/deep-somatic pain

85

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

chronic headache
osteoarthritis

86

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

87

when can't you ketorolac?

When they are bleeding (ex- on period)

88

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

muscle relaxants

89

what are some seadating tricyclic antidepressants?

amitriptyline, nortriptyline, (& trazodone- SARI)

90

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

Duloxetine, venlafaxine, desvenlafaxine

91

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

92

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

Capsaicin (don't give with zoster)
menthol

93

what are some other topical agents for pain?

Lidocaine
Ibuprofen, gabapentin

94

what are some injected local anesthetics for pain

lidocaine
marcaine

95

Stimulates nerves under skin

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

96

who normally develop an opiate addiction?

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

97

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)

98

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

99

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

Addiction

100

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

Pseudo-addiction

101

who is pseudo-addiction the fault of?

The provider

102

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

complex regional pain syndrome

103

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

CRPS-I

104

Type of CRPS that can occur w/ no injury

CRPS-II

105

who does CRPS not affect

children under 5, rarely under 10

106

who does CRPS typically affect?

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

107

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

108

what type osteoporosis is common w/ CRPS

patchy osteoporosis

109

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)

110

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

sympathetic

111

is amputation of a limb effective at controlling CRPS?

Not really, only helps 50%