W12: Neuropharmacol.; Functional Neuro Symptoms; Rehab; Cognitive Funct.

Question 1

Describe, in general terms, the sequence of events that occur during synaptic transmission

Answer 1

Ca2+ gated channels activated by Na+AP.

Vesicles of transmitters exocytosed

Diffuse across cleft + bind to postsynaptic receptors = response

Presynaptic autoreceptors inhibit further NT release (GABA-based)

• Glial/Neurone uptake of NT
  OR
• NT breakdown in cleft

Question 2

Sites blocking synaptic transmission

Answer 2

Na+ channels = block all AP (local anaesthetic)

Ca2+ channels = block NT release

Release machinery (botox)

Postsynaptic receptors: competitive/non-comp.

Activate presynaptic inhibitory receptors

↑breakdown rate

↑uptake of NT

Inhibit synth+packaging of NT

Question 3

Increasing transmission

Answer 3

• precursors
• agonist @ postsynaptic receptors (!inappt. activation)
• Block breakdown (anticholinesterases)
• block uptake of transmitter

Question 4

DA in PD

Answer 4

DA: voluntary movement; emotions/reward; vomiting
> DA cell degen. in substantia nigra = DA def in basal ganglia

• Tyr. never converted to DOPA
• DA in-vivo has wide variety of effects @ different areas
• MAO-B and COMT are key enzymes in DA breakdown

=>Stiffness, slow movements, change in posture, tremor

Question 5

PD Pharmacology

Answer 5

LEVODOPA

DA AGONISTS:
non-ergots (ergots=fibrosis)
=> ROPINIROLE, ROTIGOTINE

APOMORPHINE

+ motor dysfunct. improved
- N/V, psychosis, abn. behaviour worsened
!dyskinesia sfx

CARBIDOPA (enzyme inhibitors)
SELEGILINE (MAOB inhib.)
ENTACAPONE (COMT inhib.)
+ N/V, psychosis

Question 6

DA Antagonists

Answer 6

worsen parkonsinism but improve N/V + psychosis

!antiemetics will worsen PD (they unfortunately cross BBB and affect SN)

=> DOMPERIDONE (anti-emetic DA antag. that doesn’t cross BBB)

• LT DA-antag use = parkinsonism + dyskinesias

Question 7

patients that would benefit from rehabilitation

Answer 7

LT neuro conditions: sudden onset/intermitten/unpredictable/ static/ progressive conditions

Question 8

aims of rehabilitation

Answer 8

independence, returning close to normal, comfort and dignity, employment, QoL,

@
rehab ward, outpatient, community facilities, rehab services, at home

Question 9

WHO definition of rehabilitation

Answer 9

Active participation of disabled person and others to reduce impact of disease and disability on daily life

Question 10

physical problems that arise from long term neurological conditions

Answer 10

• weakness
• loss of/abn sens
• spasticity
• bladder/bowel
• swallowing and speech
• pain
• seizures
• fatigue

Question 11

cognitive and psychiatric/behavioural problems that arise after brain injury

Answer 11

• posttraumatic amnesia
• disorentation
• mem problems
• poor conc. and attention
• mental fatigue and slowed thinking
• poor executive funct. and planning
• impaired reasoning and problem solving

Question 12

rehabilitation process including the setting of ‘SMART’ goals

Answer 12

goal setting as part of patient process

• specific
• measurable
• achievable
• realistic
• timely

Question 13

issues that arise from spasticity, including deformity and contracture and the management of spasticity

Answer 13

Physiotherapy

Occuptational services

Question 14

prevention of secondary complications

Answer 14

!pressure sores
infections
falls
DVT
malnutrition
constipation
pain+spasticity
contractures
low morale + depression

Question 15

CI for cognitive scree

Answer 15

known learning disability; sadation; delirious/hallucinations; distressed state

Question 16

Illness behaviour

Answer 16

belief that one is threatened by illness and in need of protective action, including medical care, is typically initiated by changes in somatic experience and physical function that are interpreted as symptoms of an underlying threat to health.

Question 17

Somatisation

Answer 17

tendency to experience and communicate somatic distress and symptoms unaccounted for by pathological finding to attribute them to physical illness and to seek medical help for them

Question 18

Functional disorders

Answer 18

condition in which there is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signal

Question 19

Depression

Answer 19

varied onset; diurnal variation, poor attention intact memory

Question 20

Hypochondriasis

Answer 20

Anxiety disorder, somatisation

Question 21

Conversion disorder

Answer 21

condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.

Question 22

Dissociation

Answer 22

a

Question 23

MMSE

Answer 23

appt. for dementia

lacks dx specificity, poor sens.
fails to take into account higher cognitive resolve + vis difficulties

Question 24

Montreal Cognitive Assessment

Answer 24

rapid tool, wide age and diverse population, adjustable for lower academic achievement;

!brief screen only,

Question 25

ACE III

Answer 25

ADDENBROOKES 100Q
sensitive to AD and differentiate between AD and frontotemporal

differentiate between organic disease from psychiatric state