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Flashcards in NEURO PACKET 4 Deck (9)
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1
Q

TX for dementia
Mild- moderate: _______
Moderate – severe  _____ (Donepezil) + _____ (mematine) ((combo)

  • Nonpharmological approaches  may ↓ the rate of functional decline, ↓ demented pts caregiving needs, ↓ risk of dementia in normal individuals
    o Aerobic ____ (45 minutes most days of the week)
    o Frequent mental stimulation
     Maintaining as active a role in the family and community as practically possible
     Emphasizing activities at which the patient feels confident
     Limited capacity to regain ___skills  memory drills are more likely to lead to frustration than benefit & computerized cognitive training does not improve cognition or function
  • All forms of AD involve cholinergic degeneration of brain neurons, esp those that release ________
    o Cholinergic neuron destruction causes cholinergic deficit
     Opposite of Parkinson’s cholinergic excess
    o AD pts contain senile ____ and neurofibrillary ____ concentrated In the same regions as cholinergic deficit
    o Recent large study: AD2000 clinical trial in community dwelling patients with mild-mod AD found small and nonsignificant gains with treatment  weigh out if it is worth it if the gain is small
    o AA of Neurology, AA of Geriatric Psychiatry: use _______ inhibitors in appropriate patients – not clear who is appropriate (mild-mod, community living)
     AD characterized by functional impairment of neurotransmitter systems, including the cholinergic system
     Cholinergic decline linked to neuropsychiatric and functional deficits in AD
     4 CIs approved for tx of mild-mod AD and Lewy Body Dementia
    • Donepezil (_____) – oldest and most marketed
    • Galantamine (Razadyne)
    • Rivastigmine (______)
    • Tacrine (big side effects: hepatotoxicity) (Cognex) not used much
     Side effects include Nausea and diarrhea, uncommonly cardiac arrhythmias (do EKG prior to initiating therapy)
    o Don’t respond to cholinesterase inhibitors  Use antipsychotics
  • N-methyl-D-aspartate (NMDA) Antagonist = _______ (NAMENDA)  targets the glutamatergic system, preventing cell death – can combine with Aricept (may have combo pills)
    o Used for moderate to severe AD
    o Shows clinical benefit and good tolerability
    o Randomized, placebo-controlled study of 404 community living pts small study, still ongoing) with mod to severe AD looked at memantine (Namenda) with Aricept
     Adding memantine for 24 weeks  significantly better outcomes compared with placebo on:
    • Cognition
    • ADL (ex – can start brushing their teeth again)
    • Behavior
    • Clinical global status
  • Mood and behavioral disturbance  SSRI
    o Generally safe and well tolerated in elderly, cognitively impaired patients
    o May be efficacious treatment of depression, anxiety or agitation
    o Citolapram (_____) for agitation – or Lexapro
     side effects may occur including QTc prolongation
    o Paroxetine and TCAs should be avoided due to anticholinergic effects
    o Buproprion (Wellbrutrin) or Venlafexine (Effexor) may also be tried
  • Insomnia  TRAZADONE can be safe & effective
    o OTC antihistamine hypnotics (Benadryl) must be avoided along with benzodiazepines due to worsening of cognition and tendency to precipitate delirium
    o Other rx hypnotics such as zolpidem (Ambien) may result in similar adverse reactions
A

aricept
aricept and namenda

exercise
lost
acetylcholine
plaques
tangles
cholenisterase
aricept
exelon
memantine
celexa
2
Q

RADICULOPATHY

TREATMENT
• physical medicine : ____, use of ______(heat, cold, U/S, massage) to reduce pain
• If 2ndary to occupational hazard, train in use of ergonomics

A

exercise

modalities

3
Q

SPINAL STENOSIS

  • May need ____ consult
  • Nonsurgical management: ______, non-narcotic meds, _____ injections, pain management
A

surgical
physical medicine
epidural

4
Q

TREATMENT OF SPINAL TRUMA

• Immobilization and if there is cord compression, early decompressive ____ and _____ (within 24 hours)
• Early treatment with high dose corticosteroids (methylprednisolone 30mg/kg/h for 23 hours) may improve neurologic recovery if commenced within 8 hours after injury
• Anatomic realignment of the spinal cord by traction and other orthopedic procedures is important
• Subsequent care of residual neurologic deficit-paraplegia or quadriplegia-requires care of the skin bladder and bowels.
** do need to know a little bit about all this stuff but don’t need to know in detail … I think she means spinal cord syndromes?? Recommends having spinal tracts in front when reviewing to know sydromes

A

laminectomy

fusion

5
Q

CEREBRAL PALSY

TREATMENT:
• Cerebral palsy can’t be ____ but treatment will often improve a child’s capabilities
• ___, ___
• ____ therapy
• Drugs to control ____, relax muscle spasms, and alleviate pain
• ____ to correct anatomical abnormalities or release tight muscles
• ____ and other orthotic devices
• Wheelchairs and rolling walkers
• Communication aids such as computers with attached voice synthesizers

A
cured
PT, OT 
speech
seizures
surgery
braces
6
Q

MYASTHENIA GRAVIS

TREATMENT:
• Goal: maximize muscle ____, maintain functional ability
• Residual weakness is common
• With tmt, pts usually don’t die of this
• MG establishes within weeks to months; usually NOT progressive
• Course: spontaneous remission, remission with treatment, remissions with exacerbations
• _____ – first line if candidate for surgery
• _____
• Anticholinesterase medications – going to increase levels of acetylcholine  minimally helpful
• Immunosuppression
• immunomodulation
• Plasmapheresis
• 80% of pts go into remission post-thymectomy
• Anticholinesterase drugs: were mainstay of tmt; now steroids
• Pyridostigmine (Mestinon); neostigmine (anticholinesterase)
• Taken 30 minutes before eating to increase strength for chewing and swallowing
• MESTINON:
o No longer the mainstay of treatment because of progressive lack of effect
o Inadvertent overdosage common
o Can provide symptomatic benefit
o 30 minutes before a meal to get thru eating
o Side effects: perspiration and diarrhea can be countered by adding atropine
• CURRENT TREATMENT:
o Increasing recognition of primary autoimmune disturbance
o _______ 50 mg/d: initial drug of choice for MG
o 1st dosing: a transient worsening of weakness may occur
o Rarely, respiratory failure
o PREDNISONE:
 Continue for 2-6 months until normal strength regained
 Thymectomy recommended for all pts with generalized MG, except very young and very old (**FR - When should patient’s be considered for a thymectomy in MG?)
 Do it 3-6 weeks into prednisone therapy when pt is asymptomatic
• IMMUNOSUPPRESSIVE DRUGS: for this exam would just say immunosuppressive or immunomodulating
• Would use if still having symptoms after prednisone is discontinued
o Cyclosporin
o Mycophenolate
o Azathioprine
o Tacrolimus
o Methotrexate
o Rituximab (refractory MG)
o IVIG and plasmapheresis (work quickly; short duration of action)
• MG is a chronic disease that needs daily (sometimes hourly) skillful management
• Frequent rest periods
• Eat well-balanced, high potassium meals
• Avoid infections, undue stress
• Myasthenia Gravis Foundation: support group

A

strength
thymectomy
steroids
prednisone

7
Q

MG CRISIS

TREATMENT:
• Eliminate offending ____
• Treat _____
• _____ support
• Lasts from days to weeks (avg: 2 weeks)
• Use of high dose steroids can precipitate a crisis; CAREFUL!

A

drugs
infection
vent

8
Q

LAMBERT-EATON MYASTHENIC SYNDROME

TREATMENT:
•	Treatment of underlying \_\_\_\_ – if someone has lambert Eaton syndrome, we need to do a workup for cancer
•	IV \_\_\_
•	\_\_\_\_\_
•	Azathioprine – \_\_\_\_\_\_
•	Plasmapheresis
A

cancer
IVIG
prednisolone
immunomodulator

9
Q

AIDP - GUILLAN BARRE

TREATMENT:
• _________ (for 2 weeks or >)
• Intravenous administration of _______ (start in 1st week of sxs)
• Carefully monitor ______ status
• Mortality ~ 5%
• Most recover: 3-6 months
• 20% have permanent disabling weakness, imbalance or sensory loss

A

plasmaphoresis
gamma globulins
cardiopulmonary