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116 Cards in this Set
- Front
- Back
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alpha-agonists
glaucoma drugs & mechanism |
epinephrine
brimonidine v synthesis |
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beta-blockers
glaucoma drugs & mechanism |
timolol
betaxolol carteolol v secretion |
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diuretics
glaucoma drugs & mechanism |
acetazolamide
v secretion 2^ v HCO3- 2^ - carbonic anhydrase |
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epinephrine s/e's
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mydriasis
stinging do not use in closed-angle glaucoma (mydriasis exacerbates closed angle glaucoma) |
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cholinomimetics for glaucoma: s/e's on the eye
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CholinoMimetics
Cyclospasm Miosis 2^ contraction of ciliary muscle & sphincter |
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latanoprost s/e
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darkens iris
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latanoprost is a ...
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an anolog of prostaglandin F 2-alpha
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latanoprost moa
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^ outflow
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cholinomimetics
glaucoma drugs & mechanism |
direct
--pilocarpine --carbachol indirect --physostigmine --echothiophate -- ^ outflow -- contract ciliary muscle --> open trabecular meshwork |
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_ is drug for acute angle closure glaucoma
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pilocarpine
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3 opioid receptors
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mu = morphine
delta = enkephalin kappa = dynorphin |
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opioid analgesics mechanism
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oPen Potassium K+ channels
Close Ca++ channels --> v synaptic transmission inhibit release of substance P and SANG: serotonin, ACh, NE, glutamate |
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cough suppression
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dextromethorphan
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opioids for diarrhea
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loperamide
diphenoxylate |
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opioids Rx
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pain
--Cough suppression (dextromethorphan) --Diarrhea (loperamide, diphenoxylate) --acute pulmonary Edema |
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opioid analgesics s/e's
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"CAMeRA"
constipation addiction miosis respiratory depression additive CNS depression |
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treat opioid toxicity with
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naloxone
naltrexone (these are opioid receptor antagonists. aka Narcan) |
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tolerance does not develop to opioids' ______
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miosis
constipation |
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_ causes less respiratory depression than opioids b/c moa...?
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butorphanol
partial agonist at mu agonist at kappa |
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butorphanol moa
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partial agonist at mu
agonist at kappa |
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butorphanol s/e
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withdrawal if on full agonist
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tramadol moa
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S^O^N
very weak Opioid agonist inhibits Serotonin reuptake inhibits NE reuptake |
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tramadol Rx
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chronic pain
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tramadol s/e
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similar to opioids
lowers seizure threshold |
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mlf syndrome aka
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internuclear ophthalmoplegia
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internuclear ophthalmoplegia--
(5) |
--aka MLF (medial longitudinal fasciculus) syndrome
--medial rectus palsy on attempted lateral gaze --nystagmus in abducting eye --normal convergence --MS patients |
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_ pts have ^ risk of Alzheimer's
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Down syndrome
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familial alzheimer's genes
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Early onset
--APP --presenilin-1 --presenilin-2 Late onset --ApoE4 ------------------------------ ApoE2 is protective |
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dementia definition
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v
cognitive ability memory function with intact consciousness |
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alzheimer's findings
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cortical atrophy
v ACh senile plaques neurofibrillary tangles |
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senile plaques
vs neurofibrillary tangles |
senile plaques: extracellular beta-amyloid
-->amyloid angiopathy --> hemorrhage neurofibrillary tangles: intracellular phosphorylated tau --> insoluble cytoskeletal tangles correlate with degree of dementia |
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beta amyloid synthesis
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from cleaving APP (amyloid precursor protein)
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pick's disease
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DAP PAP
dementia aphasia parkinsonism --personality changes --atrophy: frontotemporal, except not posterior 2/3 of superior temporal gyrus --Pick bodies (intracellular aggregated tau) |
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Lewy body dementia sxs
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Houston PD
hallucinations parkinsonism dementia |
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Lewy body dementia cause
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alpha-synuclein defect
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alpha-synuclein defect causes
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Lewy-body dementia
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prion protein structural pathophys
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alpha helix --> beta-sheet [resistant to proteases]
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clinical features of Creutzfeld-Jacob
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rapidly progressive (weeks to months)
myoclonus |
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myoclonus
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brief, involuntary twitching
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misc. causes of dementia (5)
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intellectually, VHS is a WMd
Vitamin B12 deficiency HIV Syphilis Wilson's disease Multi-infarct (2nd most common cause in elderly) {d = dementia's misc. causes!} |
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MS is ____
epidemiology |
autoimmune demyelination
relapsing/remitting course women 20's & 30's whites |
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MS sxs
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the Holy Hallooing MOB committed a S I I I N
hemiparesis hemisensory MLF syndrome optic neuritis bladder/bowel scanning speech intention tremor --incontinence --internuclear ophthalmoplegia nystagmus |
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MS rx
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--beta-interferon
--immunosuppressants symptomatic rx for --neurogenic bladder --spasticity --pain |
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MS dx
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M O P =
MRI oligoclonal bands (IgG) in CSF periventricular plaques (oligodendrocyte loss; reactive gliosis) |
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Guillain-Barre is
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autoimmune
demyelination peripheral nerves motor fibers of central roots (sensory effect is less severe) |
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Guillain-Barre sxs
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symmetric ascending weaknesss
facial paralysis in 50% of cases autonomic sxs (cardiac, htn, hypotn) |
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Guillain-Barre prognosis
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almost all recover in weeks to months
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Guillain-Barre dx
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^ CSF protein (--> papilledema)
normal cell count =albuminocytologic dissociation |
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GBS is associated with...
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Campylobacter jejuni
herpesvirus vaccination stress |
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GBS rx
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**respiratory support**
(b/c can affect diaphragm) plasmapheresis IV Ig |
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misc. demyelinating and dysmyelinating diseases
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progressive multifocal leukoencephalopathy
acute disseminated (postinfectious) encephalomyelitis metachromatic leukodystrophy charcot-marie-tooth disease |
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PML (5)
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demyelination of CNS
JC virus --> destruction of oligodendrocytes 2-4% of AIDS pts reactivation of latent JC infection rapid. usu. fatal |
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acute disseminated encephalomyelitis (4)
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PIMP=
postinfectious inflammation & demyelination multifocal perivenular |
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what can lead to acute disseminated encephalomyelitis?
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infections: e.g. measels, chickenpox
vaccinations: e.g. rabies, smallpox |
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metachromatic leukodystrophy (4)
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recessive
lysosomal storage disease arylsulfatase A deficiency sulfatide buildup --> impaired production of myelin |
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Charcot-Marie-Tooth disease aka
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HMSN = hereditary motor & sensory neuropathy
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Charcot-Marie-Tooth disease clinical presentation (4)
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LE muscle atrophy --> inverted bottle
initially affects peroneal nerve progressive |
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a seizure is
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synchronized, high-frequency firing
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partial seizures
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--one area of brain
--most commonly originates in mesial temporal lobe --often preceded by aura --can secondarily generalize |
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partial seizures 2 types
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simple--consciousness intact
complex--impaired consciousness |
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generalized seizures start where?
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both hemispheres, from beginning of seizure
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5 types of generalized seizures
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absence
myoclonic tonic-clonic tonic atonic |
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absence seizures
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petit mal
3 Hz no postictal confusion blank stare |
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myoclonic
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quick, repetitive jerks
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tonic-clonic is aka
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grand mal
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lateralization:
migraine tension cluster |
tension is bilateral
the other two are unilateral |
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migraine aura may include _
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visual
sensory speech |
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migraine description (5)
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your UH degree is N/A if you're going to PPP on campus like that
unilateral 4-72 hours nausea +/- aura pulsating pain photophobia phonophobia |
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migraine is due to
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irritation of CN V
release of substance P CGRP vasoactive peptides |
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migraine rx
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propranolol
NSAIDs sumatriptan for acute |
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tension headache
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bilateral
>30 min steady pain |
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cluster headache
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males much more commonly BURP and HuRL
unilateral brief headaches repetitive periorbital pain Horner's Rhinorrhea ipsilateral Lacrimation >> common in males |
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misc causes of headache
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hydrocephalus
arteritis meningitis neoplasia |
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vertigo is...
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illusion of movement (you or the room)
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vertigo types
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peripheral
central |
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adult brain tumors in order from peak incidence
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the GM is a SOP
glioblastoma multiforme meningioma schwannoma oligodendroglioma pituitary adenoma |
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childhood brain tumors in order from peak incidence
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if you want to make a Pile of Medical Appendages, you'll need a He-man or a Crane
pilocytic astrocytoma medulloblastoma ependymoma hemangioblastoma craniopharyngioma |
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mass effects of brain tumors include (3)
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seizures
dementia focal lesions |
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3 general remarks about brain tumors
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1^ brain tumors rarely metastasize
mostly: adult 1^ tumors--supratentorial child 1^ tumors--infratentorial --half of adult tumors are metastases (usu. @ gray-white junction) |
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notable brain tumors that are astrocytomas. stain for _
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glioblastoma multiforme
pilocytic astrocytoma GFAP |
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glioblastoma multiforme basic description
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1-year life expectancy
cerebral hemispheres "butterfly glioma" (can cross corpus callosum) astrocytes stain for GFAP |
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glioblastoma multiforme morphology (2)
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"pseudopalisading" pleomorphic cells surrounding
central necrosis & hemorrhage |
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meningioma basics (3)
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@ convexities of hemispheres & parasaggital region
arises from arachnoid cells resectable |
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meningioma morphology
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spindle cells concentrically in a whorled pattern
psammoma bodies |
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schwannoma (5)
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often localized to CN VIII
--> acoustic schwannoma resectable cerebellopontine angle S-100 bilateral schwannoma is seen in neurofibromatosis type 2 |
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oligodendroglioma (5)
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rare
slow-growing frontal lobes |
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psammoma bodies are
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laminated calcifications
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oligodendroglioma morphology (3)
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oligodendrocytes "fried egg" cells -- round nuclei, clear cytoplasm, perinuclear halos
"chicken-wire" capillary pattern often calcified |
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pituitary adenoma: usu _. a symptom: __. 2 sequelae.
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prolactinoma
bitemporal hemianopia hyper- or hypopituitarism |
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_ gives rise to anterior pituitary
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rathke's pouch
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pilocytic astrocytoma (4)
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usu in posterior fossa
may be supratentorial GFAP benign |
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pilocytic astrocytoma morphology (2)
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Rosenthal fibers -- eosinophilic, corkscrew fibers
cystic + solid |
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medulloblastoma (4)
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--highly Malignant
--cerebellar --PNET (it's a primitive neuroectodermal tumor) --can compress 4th ventricle --> hydrocephalus |
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medulloblastoma morph (4)
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--rosettes or
perivascular rosettes --solid --small blue cells --radiosensitive |
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ependymoma (3)
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most commonly found in 4th ventricle
can cause hydrocephalus poor prognosis |
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ependymoma morphology (2)
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perivascular pseudorosettes
rod-shaped blepharoplasts near nucleus |
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hemangioblastoma (3)
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usu cerebellar
assoc. with von Hippel-Lindau if found with retinal angiomas can --> EPO --> polycythemia |
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hemangioblastoma morph
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foamy cells
high vascularity |
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craniopharyngioma (5)
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benign
can --> bitemporal hemianopsia most common childhood supratentorial tumor from remnants of Rathke's pouch Calcification is common (tooth-enamel like) |
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4 types of herniation syndromes
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cingulate (subfalcine) -- under falx cerebri
transtentorial uncal cerebellar tonsillar into foramen magnum |
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_ herniation can compress _ artery
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cingulate (subfalcine)
anterior cerebral artery |
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peripheral vertigo (3)
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more common
inner ear etiology --semicircular canal debris --vestibular nerve infection --Meniere's delayed horizontal nystagmus |
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central vertigo (2)
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brain stem or cerebellar lesion
--vestibular nuclei --posterior fossa immediate nystagmus in any direction. may change directions. |
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Sturge-Weber
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it's fun to Play Inside PVC
My GoSH! pheochromocytomas ipsilateral leptomeningeal angiomas port-wine stains V1 distribution congenital, sporadic can --> mental retardation glaucoma seizures hemiparesis |
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tuberous sclerosis
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SS SSclerosis is HA RRR D
subependymal giant cell astrocytoma seizures shagreen patch sebaceous adenoma hamartomas (CNS, skin, organs) "ash leaf spots" cardiac Rhabdomyoma renal angiomyolipoma retardation dominant |
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neurofibromatosis type I is aka
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von Recklinghausen's
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port-wine stains aka
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nevus flammeus
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neurofibromatosis type I
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P
CLOwN N D Cafe-au-lait spots Lisch nodules (pigmented iris hamartomas) Optic gliomas neurofibromas pheochromocytomas NF-1 gene (17) dominant |
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von Hippel-Lindau disease
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BCD, HPV
--bilateral renal cell carcinoma --cavernous hemangiomas (skin, mucosa, organs) --dominant --hemangioblastoma (retina, brain stem, cerebellum) --pheochromocytomas --VHL (tumor suppressor) (3) |
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uncal herniation signs (4)
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pupil dilation/proptosis -- 2^ stretching CN III
contralateral homonymous hemianopia -- 2^ compression of ipsilateral posterior cerebral artery ipsilateral paresis 2^ compression of contralateral crus cerebri Duret hemorrhages --paramedian artery rupture |
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what artery supplies occipital cortex?
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posterior cerebral
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uncal herniation: compression of contralateral crus cerebri is aka
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Kernohan's notch
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metastases are *usually* _ enhancing
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ring-enhancing
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ring-enhancing lesions
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metastases
abscesses toxoplasmosis AIDS lymphoma |
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uniformly-enhancing lesions
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lymphoma
meningioma metastases (usu ring-enhancing) |
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heterogeneously-enhancing lesion
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glioblastoma multiforme
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