Neurology class 2 Flashcards by abby wright

norepinephrine/epinephrine

mainly excitatory; drives motivation

How well did you know this?

Not at all

Perfectly

dopamine

mainly excitatory; reward and pleasure

How well did you know this?

Not at all

Perfectly

serotonin

inhibitory; does not require enzyme for transport; balances mood

How well did you know this?

Not at all

Perfectly

GABA

inhibitory; decreases cell activity

How well did you know this?

Not at all

Perfectly

Glutamate

excitatory; memory and learning

How well did you know this?

Not at all

Perfectly

substance P

excitatory; deals with synaptic communication

How well did you know this?

Not at all

Perfectly

monoamines

dopamine, epinephrine, norepinephrine
- recycled in the synapse by monoamine oxidase

How well did you know this?

Not at all

Perfectly

alzheimer’s disease

64% of all dementia
- cannot cure but treat with increasing ACh through cholinesterase inhibitors

How well did you know this?

Not at all

Perfectly

cholinesterase inhibitors

decrease Ach breakdown

How well did you know this?

Not at all

Perfectly

Rivastigmine, Galantamine

cholinesterase inhibitors

How well did you know this?

Not at all

Perfectly

alzheimer’s pathophysiology

breakdown and recycling of amyloid proteins–> accumulation of amyloid deposits–> amyloid plaques which interfere with communication–> loss of neurons

How well did you know this?

Not at all

Perfectly

Parkinsons

2nd most common form of dementia
- no cure but can treat with increasing dopamine

How well did you know this?

Not at all

Perfectly

levodopa, Rotigotine

dopamine agonists

How well did you know this?

Not at all

Perfectly

parkinson’s pathophysiology

destruction of dopamine receptors leading to reduced transmission in basal ganglia which filters extra and purposeful movement

How well did you know this?

Not at all

Perfectly

hypothalamic SCN

generates hormones and is the “computer” of the brain

How well did you know this?

Not at all

Perfectly

melatonin

secreted from pineal gland located in the epithalamus
tryptophan–> serotonin–> melatonin

How well did you know this?

Not at all

Perfectly

sleep cycle

circadian rhythm input from hypothalamic SCN–> decreased RAS and cortical stimulation–> decreased excitatory neurotransmitter stimulation

How well did you know this?

Not at all

Perfectly

REM sleep stage

“wakeful” vital signs but in very deep sleep

How well did you know this?

Not at all

Perfectly

Insomnia

difficulty falling and staying asleep which can be caused by high cortisol
- often at least one ADL is altered alongside

How well did you know this?

Not at all

Perfectly

Flurazepam (Dalmane), Temazepam (Restoril), Triazolam

benzodiazepines for insomnia
- will cause pupil dilation due to PNS block

How well did you know this?

Not at all

Perfectly

Sonata, Ambien, Lunesta

non-benzodiazepines for insomnia
- bind with GABA but from different angle

How well did you know this?

Not at all

Perfectly

will cause pupil constriction

opioids

How well did you know this?

Not at all

Perfectly

will cause pupil dilation

stimulants

How well did you know this?

Not at all

Perfectly

obstructive sleep apnea

has nothing to do with neurotransmitters it deals with collapse of airways; common in obese patients
- common in REM stage
- common due to increased pressure on diaphragm which decreases mobility

How well did you know this?

Not at all

Perfectly

obstructive sleep apnea pathophysiology

pharynx collapse--> pharyngeal wall collapse--> tongue obstruction of oropharynx

cerebral apnea

deficit in the brain stem and respiratory centres

migraine

must occur for at least 15 days within a month for 3 months - higher incidence in adult women due to estrogen levels

migraine pathophysiology

trigeminal nerve irritation--> inflammation within meningeal

migraine without aura

most common form of migraine

serotonin agonists

treat migraines to balance brain activity

triptans (sumatriptan, zolmitriptan)

serotonin agonists

botox as treatment for migraines

acts as an antiinflammatory to decrease neurotransmitter hyperstimulation

anxiety

intense fear due to SNS and HPA axis stimulation leading to S&S of anxiety - women more affected but present in 12% of the population

excessive and uncontrollable worry with systemic symptoms and unable to modulate with present coping mechanisms

generalized anxiety

intense fear with systemic symptoms - CNS involves major emotional centers (amygdala, hippocampus, prefrontal cortex) - SNS stimulation

panic

benzodiazepines for anxiety

increase inhibitory neurotransmitter GABA

Alprazolam (Xanax), diazepam (Valium), Lorazepam (ativan), Midazolam (Versed)

benzodiazepines for anxiety

hallucinations

abnormalities of sensory perception - perception without real time input

sensory block (hallucinations)

stored images replace the intel coming in

neuronal dysfunction (hallucinations)

hyperactivity or deficit creates dysfunction and images

delusions

abnormalities of thought - false beliefs in facts and or personal status

psychosis

state of perceptive loss of reality - hallucinations and delusions

schizophrenia

dysfunction of thoughts and language expression which is chronic - cause is unknown but will show up on MRI - dopamine excess

incomprehensible speech, disconnected thought process

disorganized behaviour of schizophrenia

hallucinations, delusions, paranoia, agitation

psychotic (positive) behaviour of schizophrenia

schizophrenia diagnosis

at least 2 S&S plus 2 other functional alterations

antipsychotics

target limbic system D2 receptors which deals with emotions; decrease hyperexcitation of the brain

D2 antagonism in basal ganglia cause issues with tongue movement, muscle rigidity, tremors, restlessness , and muscle spasms

Extrapyramidal side effects of antipsychotics

neuroleptic malignant syndrome

VS crisis characterized by hyperthermia, unstable BP, incontinence, and diaphoresis

schizoaffective disorder

schizophrenia accompanied with another disorder

'typical' antipsychotic drugs

high efficacy for 'positive' (psychotic) symptoms

phenothiazines and non-phenothiazines

'typical' antipsychotic drugs

chlorpromazine

type of phenothiazine (antipsychotic)

haloperidol

type of non-phenothiazine (antipsychotic)

olanzapine (zyprexa), quetiapine (seroquel), clozapine (clozaril), risperidone (risperdal)

'atypical' antipsychotic drugs

high efficacy for 'positive' and negative symptoms and cause less sedation

depression

lack of serotonin and norepinephrine, may be accompanied by hallucination and delusions ** make sure to rule out hypothyroidism due to similar symptoms

SSRI's

"ine" ; 1st line drugs that take 1-2 weeks to take effect

Fluoxetine (prozac), sertraline (zoloft), paroxetine (Paxil)

SSRI's

SNRI (atypical antidepressants)

increase serotonin and norepinephrine

Mirtazapine (Remeron), Bupropion (Wellbutrin)

SNRI

tricyclic antidepressants

serotonin, norepinephrine, and dopamine reuptake inhibitors

Imipramine (Impril)

tricyclic antidepressants

MAO inhibitors

inhibit monoamine oxidase enzyme which increases neurotransmitter presence

ketamine

dissociative anesthetic; its receptors are glutamate, serotonin and opioid - when used for anesthetic the dose is 10x lower

Esketamine

type of ketamine

Lithium

sodium channel blocker that increases serotonin and decreases sodium to decrease impulsivity and mood swings - narrow TI, toxicity, slow onset, drug interactions

loss of sensation in a focused area of the body - used for minor procedures such as sutures

local anesthesia

loss of sensation in a body region - used in dental procedures

regional anesthesia

systemic; loss of consciousness and combines many drugs for an optimal effect - used for major procedures such as abdominal surgery

general anesthesia

systemic; low level sedation to maintain VS without intubation

monitored anesthesia care (MAC)

sleepy, able to awaken, able to respond when prompted, maintain VS without assistance

conscious sedation

sedation of a patient for the purposes of a medical procedure/intervention

anesthesia

"sodium channel blockers" - impede action potential so cell cannot depolarize leading to decreased sensory impulses to other cells - work on efferent and afferent pathways - lipophilic, cleared through circulation, hepatic metabolism, no BBB significance

local anesthetics

"caine" - Prilocaine, Lidocaine, Bupivacaine, Ropivacaine, Cocaine

local anesthetics or "sodium channel blockers"

shortest acting local anesthetic

Lidocaine

longest acting local anesthetic

Bupivacaine

known to be systemic, very lipophilic, vasoconstriction at local level

cocaine

topical, infiltration, nerve block, epidural, spinal

local anesthetic routes

solarcaine

topical anesthetic

used as an adjunct in anesthesia - localizes vasoconstriction which helps with bleeding control and increases the duration of the anesthetic

Epinephrine

used as an adjunct in anesthesia - helps neutralize the pH of a tissue in case of a bacterial infection

sodium bicarbonate

location ensured by no CSF return in needle - there will be a loss of sensation to the spinal nerves as the anesthetic bathes the nerves - onset will be in 20-30 min and there will be a continuous infusion through an indwelling catheter - dosage is higher than spinal route

epidural

location ensured by CSF return in needle drawback - always injected below L2 - quick onset

spinal anesthetic route

very little side effects, can use small amounts due to its potency, analgesic

fentanyl

cause good analgesia without euphoric effects, has depressive symptomologies, good for patients with previous addictions

Dilaudid

"thane"; decrease action potentials, increase GABA

inhaled general anesthetics

nitrous oxide, halothane, isoflurane

inhaled general anesthetics

propofol (diprivan)

IV anesthetic

increase GABA and has a rapid onset of action as well as a short half life - requires continuous infusion for effect and requires intubation as well as VS support

Propofol (Diprivan)

dissociative anesthetic that is also a CNS depressant

ketamine

block Ach binding at nicotinic receptors; "nium" - no BBB penetration just PNS - muscle paralysis including the diaphragm - ideal for complex procedures

neuromuscular blocking agents

vecuronium, rocuronium, pancuronium

neuromuscular blocking agents