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33 Cards in this Set
- Front
- Back
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Partial seizures
Bilateral or unilateral neuronal involvement? Local onset? Originate where? Generally caused by? |
Involves neurons unilaterally
Often have local onset Usually originates from cortical brain tissue Often caused by tumor or underlying problem |
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Generalized seizures
Bilateral or unilateral neuronal involvement? Local onset? Originate where? Is consciousness maintained? Name 2 types? |
Bilateral neuronal involvement
Usually do NOT have local onset Usually originate from a subcortical (thalamus, limbic system, not cortex) or deeper brain focus Consciousness is always impaired or lost Absence, tonic clonic, myoclonic, atonic |
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Define status epilipticus.
Is it an emergency? Why or why not? |
Seizures lasting > 30 min or subsequent seizure prior to full recovery of previous (In postical state).
Yes, it is a medical emergency b/c the brain can become hypoxic, resulting in death or extreme brain damage. |
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Seizure provoking factors. (7)
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Alcohol (> 2 drinks triples likelihood of seizure)
Nutritional deficiencies (hypoglycemia, low B6, Na+, Ca2+, Mg2+) Drug abuse (cocaine, amphetamines) OTC drugs (beadryl) Menstrual period (catamenial seizures) Sleep deprivation Stress |
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Describe the pathophysiology of Alzheimer's Diease
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Neurofibrillary tangles and neuritic plaques in the cerebral cortex & hippocampus.
Tangles destroy microtubles; decreased Tau protein associated. Plauqe forms from protein pieces of beta amyloid that clump together Loss of neurons in hippocampus and area of cortex that plays key role in new memory formation is seen. |
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Describe some of the clinical presentation of Alzheimer's Disease.
When are you likely to see Parkinson type symptoms with AD? |
Progressive forgetfulness
Decreased ability to concentrate Progressive decline in abstract thinking, problem solving, judgment, mathematical ability. Agitation and irritability are common, esp in early stages. If frontal lobe of cortex is involved motor changes and Parkinson's type problems may be seen (rigidity and flexion posturing) |
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Parkinson Disease
What part of brain is affected? Which neurotransmitter is associated? |
Degenerative disorder of the basal ganglia.
DA secreting neurons in substania nigra are progressively lost |
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Multiple Sclerosis
What happens to nerves in MS? Is there a genetic component to the disease? What are some of the immune responses seen/involved? |
Demyelination and plaque formation on nerves slows impulses in CNS.
Yes, there is a specific haplotype for MS susceptibility genes that alter body's immune response in some types of MS. CD8 & T-cells attack myelin Increase in pro-inflammatory cytokines Integrins facilitate passage of immune cells into CNS Chemokines increase, promoting migrateion of immune cells Antibodies contribute to inflammatory response |
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Amyotrophic lateral sclerosis (ALS)
Involves which motor neurons? Is remission common? Give clinical manifestations |
Upper and lower motor neurons degenerate, reulting in progressive muscle wasting and scarring of corticospinal tract.
Usually no remission, progressive to paralysis. Muscle weakness, starting in single groups and progressing; no associated mental, sensory or autonomic symptoms; deep tendon reflexes absent |
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Guillain-Barre Syndrome
Normally affects which nerves? What often triggers? Clinical manifestations? |
Acquired inflammatory disease that results in demyelination of peripheral nerves.
Often preceded by viral infection Paralysis, respiratory insufficiency, ANS instability |
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Myesthenia Gravis
What neurotrasmitter is involved? Characterized by? |
Antibodies are produced against ACh receptors @ neuromuscular junctions.
Characterized by muscle weakness and fatigability. Some may have local symptoms, some may have systemic effect. |
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Migraines
What nerve involved? What neurotransmitter is thought to be involved? Common prodromal symptoms? |
Trigeminal nerve is involved, releases neuro-inflammatory peptides. Trigeminal nerve becomes sensitized.
Serotonin 5HT initially causes vasoconstriction, eventually leading to vasodilation, causes pain and further irritating nerves in the area Visual and sensory deficits are common. May also have scalp tenderness, photophobia, auras. |
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Thrombotic stroke
Caused by? Risk factors? |
Arterial occulsions caused by thrombi in arteries supplying brain or intracranial vessels.
Risk factors artherosclerosis (most common), diabetes mellitus, elevated cholesterol, sedentary lifestyle |
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Embolic stroke
Caused by? What is arrhythmia commonly associated with emobolic stroke? Risk factors? |
Involves fragments that break off from a thrombus formed outside brain.
Atrial fibrillation a-fib, MI, endocarditis, rheumatic heart disease, valvular prostheses |
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Hemorrhagic stroke
What differentiates this from thrombotic or embolic stroke? |
Caused by intracranial hemorrhage from HTN, ruptured aneurysms, arteriovenus malformation, bleeding into a tumor
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What are the 4 main ways AEDs prevent or suppress seizure activity.
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Block Na+ channels
Block Ca2+ channels Potentiates GABA (neurotransmitter that prolongs channel openings) Inhibit glutamate (excitatory) |
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Describe 3 types of Extrapyramidal effects?
Are older or newer antipsychotics associated with EPS? Any specifically? Which neurotransmitter receptor is involved? |
Parkinsonian symptoms (altered gain, rigid movement)
Neuroleptic malignant syndrome (hyperthemia, muscle rigidity-life threatening) Tardive dyskinesia-results from prolonged use, repetitive involuntary movements Older antipyschotics with high potency are more likely to cause EPS, esp trifluoperazine and haloperidol. D2 receptors are blocked to decrease dopamine, but can cause EPS |
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Name 2 enzymes required for synthesis of dopamine?
Name 4 involved in the breakdown of dopamine? |
Synthesis:
Tyrosine hydroxylase (tyrosine to DOPA) and DOPA decarboxylase (DOPA to dopamine) Breakdown: DA-B hydroxylase (dopamine to NE) Phenylethanolamine-N-methyltransferase (NE to epineph) MAO (dopamine to DOPAC) COMT (dopamine to 3-metho/DOPAC to HVA) |
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Parkinson's drugs
Which are dopamine agonists? (3) Anticholinergics? (2) Dopamine precursors? (2) MAO-B inhibitors? COMT inhibitors? |
Dopamine agonists: pramiperxole (Mirapex), ropinirole (Requip), bromocriptine (Parlodel)
Anticholinergics- benztropine (Cogentin), trihexyphenidyl (Artane) Dopamine precursors-levodopa and levodopa + carbadopa MAO-B inhibitors: selgiline (Eldepryl) and rasagiline (Azilect) COMT inhibitors-tolcapone (Tasmar), entacapone (Comtan) |
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Why are BZDs safer than barbiturates?
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BZDs have weaker effects on respiratory depression than barbiturates
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Contraindications & Caution for Beta Blockers?
ABCDE |
ABCDE:
Asthma Block (heart block) COPD Diabetes mellitus Electrolyte (hyperkalemia) |
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Calcium Channel Blocker usage
Think of C2 MASH: or CHASM |
Cerebral vasospasm & CHF
Angina Migranes Atrial flutter, fibrillation Supraventricular tachycardia Hypertension "CHASM": Cererbral vasospasm / CHF Hypertension Angina Suprventricular tachyarrhythmia Migranes |
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Warfarin (Coumadin): metabolism
Think SLOW |
SLOW:
· Has a slow onset of action. · But is quicK Vitamin K antagonist Small lipid-soluble molecule Liver: site of action Oral route of administration. Warfarin |
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Amiodarone: action, side effects
6Ps |
6 P's:
Prolongs action potential duration Photosensitivity Pigmentation of skin Peripheral neuropathy Pulmonary alveolitis and fibrosis Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism |
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Nonselective beta-blockers
"Tim Pinches His Nasal Problem" (because he has a runny nose...): |
"Tim Pinches His Nasal Problem" (because he has a runny nose...):
Timolol Pindolol Hismolol Naldolol Propranolol |
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Hyperthyroidism: signs and symptoms
THYROIDISM |
THYROIDISM:
Tremor Heart rate up Yawning [fatigability] Restlessness Oligomenorrhea & amenorrhea Intolerance to heat Diarrhea Irritability Sweating Musle wasting & weight loss |
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Alkalosis vs. acidosis: directions of pH and HCO3
ROME |
ROME:
Respiratory= Opposite: · pH is high, PCO2 is down (Alkalosis). · pH is low, PCO2 is up (Acidosis). Metabolic= Equal: · pH is high, HCO3 is high (Alkalosis). · pH is low, HCO3 is low (Acidosis). |
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Cardioselective betablockers
"Betablockers Acting Exclusively At Myocardium" |
"Betablockers Acting Exclusively At Myocardium"
· Cardioselective betablockers are: Betaxolol Acebutelol Esmolol Atenolol Metoprolol |
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Class IB Antiarrhythmics
"Medical Lab Technician" Class IC Antiarrhythmics FEP Class III Antiarrhythmics SIBA Beta 1 Selective Blockers A-BEAM |
Class 1B Antiarrhythmics
Medical Lab Technician M exilietine L idocaine T ocainide Class IC Antiarrhythmics FEP F lecainide E ncainide P ropafenone Class III Antiarrhythmics SIBA S otalol I butilide B retylium A miodarone Beta 1 Selective Blockers A-BEAM A cebutalol B etaxolol E smolol A tenolol M etoprolol |
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Drugs Causing Agranulocytosis
The 3Cs |
C lozapine
C olchicine C arbamazepine |
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Short Acting Benzodiazepines
TOM thumb |
TOM thumb
T riazolam O xazepam |
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Beta receptor activity
Remember you have 1 heart & 2 lungs |
1 heart, 2 lungs
Beta-1 receptors are primarily on the heart, and the airway is Beta-2 receptors |
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Anti-arrythmics: for AV nodes
"Do Block AV" |
Do Block AV
D igoxin B -blockers A denosine V erapamil |
