Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
83 Cards in this Set
- Front
- Back
Arousal |
degree of sensory stimulation required to keep an individual at optimum level of cognitive function. Controlled by reticular activating system that extends from lower third of pons to thalamus. |
|
Consciousness |
state of awareness of self and environment. Made of two components: arousal and content (emotion and thought). |
|
Sleep |
active, recurrent, physiologic state that includes a reduction in consciousness and necessary fro health/well-being |
|
Non-REM sleep |
sleep stages N1, N2, N3 (slow-wave sleep). |
|
REM sleep |
Rapid eye movements, dreaming, increased respiratory rate/ body temp / blood flow / O2 consumption / penile erection. Muscle tone is absent. This type of sleep is not required but preferred. |
|
Control of Wakefulness |
locus ceruleus (NE), raphe nuclei (5-HT), tuberomammillary nucleus (H1), ventral periaqueductal gray matter (DA), some basal forebrain/brain stem (Ach), and hypocretinergic lateral hypothalamus |
|
Control of Sleep |
Reduction in neurons firing in wakeful centers, increase GABA firing |
|
"sleep factors" that build up in the brain |
adenosine, nitric oxide, prostaglandin D2. |
|
Attention |
cognitive function, focusing on relevant stimuli and ability to shift to other stimuli as they become relevant. |
|
Delirium |
Primarily due to a disorder of attention. Can have a disturbance of consciousness, decreased cognitive abilities, or hallucinations. Subacute onset. |
|
Lesions in ________ areas can lead to delirium. |
NE and ACh neurons in brain stem reticular activating system and basal forebrain. |
|
Lethargy |
abnormal state which the patient can be aroused with mild (non-noxious) stimulation |
|
Stupor |
abnormal state which the patient can be aroused with only vigorous/forceful/often noxious stimulation and still be cognitively impaired. |
|
Coma |
abnormal state which the patient cannot be aroused even with vigorous stimulation. Different from sleep in almost all ways. |
|
Lesion in the basis pontis |
Locked-in state. Normal consciousness but paralyzed, preservation of vertical eye movements |
|
Diffuse cerebral cortical lesion |
vegetative state. normal arousal and sleep cycles. No higher brain functions. |
|
Bilateral medial frontal lesion. |
Akinetic mutism. normal arousal and sleep cycles. Some higher brain function but inability to initiate thought, movement, and speech. |
|
Lesions in these two areas can produce impaired consciousness (stupor or coma). |
Reticular activating system or both cerebral hemispheres. |
|
Focal supratentorial lesion with herniation |
Decreased consciousness from "pressure dysfunction" causing pushing on the brain stem |
|
Focal lesion of reticular activating system (diencephalon, midbrain, pons) |
decreased consciousness, clinical picture of focal brain stem dysfunction that does not fit picture of cerebral transtentorial herniation. |
|
Diffuse or multifocal lesion of bilateral cerebral hemispheres |
Most common cause of impaired consciousness. |
|
CNS depressant dose dependent degree of depression |
Sedation --> sleep induction --> Loss of consciousness --> anesthesia --> Coma --> fatal depression |
|
Difference between barbituates and benzodiazepines with regards to CNS depression. |
Overdose with benzodiazepines does not cause fatal respiratory depression or coma while barbituates can. |
|
Benzodiazepines |
Enhance GABAa. Highly effecatious sedative hypnotic used for insomia. Can have psychomotor impairment, anterograde amnesia, tolerance, physical dependence, rebound insomnia. |
|
Zolpidem |
Novel benzodiazepine receptor agonists - bind to GABAa R. Most widely prescribed hypnotics - fewer deleterious effects. |
|
Ramelteon |
melatonin R (MT1 and MT2) agonist. Maintenance of circadian rhythm, help to initiate sleep. Far less efficacious than GABA acting drugs. |
|
Suvorexant |
orexin (hypocretin R antagonist). Used for tx of insomnia. |
|
Barbituates |
Bind to allosteric site on GABAa. Dangerous side effects lead to low use as sedative - hypnotics |
|
diphenhydramine |
first generation antihistamines (H1). May decrease sleep latency but not proven to increase total sleep. Residual daytime sedation, some anti muscarinic AE. |
|
Drugs used for insomnia |
Benzodiazepines, barbituates, ramelteon, suvorexant, diphenhydramine |
|
MOA of drugs used for insomnia |
enhance GABAa transmission, melatonin receptor agonists, H1 R antagonist |
|
Stimulants |
psychoactive drugs that temporarily improve mental/physical function. Can improve mood, reduce anxiety, lead to euphoria, stimulate respiration, suppress appetite. |
|
Four most common stimulants |
caffiene, theophylline, theobromine. Agonist activity at adenosine A1 and A2. Nicotine - nicotinic cholinergic receptors. |
|
Amphetamine |
taken up by DAT, NET, SERT and interferes with VMAT increasing catecholamine release. Increases arousal, decreased need for sleep, euphoria, psychosis. Tx: ADHD, narcolepsy |
|
Methylphenidate |
inhibits NET and DAT. Tx: ADHD, narcolepsy |
|
atomoxetine |
inhibits NET. Not a psychostimulant but increases alertness in ADHD. |
|
Modafinil |
psychostimulant inhibits both NET and DAT. Reduces sleepiness with low abuse potential. Tx: narcolepsy, shift-work sleep disorder, obstructive sleep apnea |
|
Sodium oxybate (GBH) |
CNS depressant, analog of GABA acting at GBH receptors. Improves quality of sleep. Tx: narcolepsy, severe cataplexy (transient attach of muscle weakness) |
|
Drugs used to promote wakefulness |
Modafinil, amphetamines, methylphenidate, sodium oxybate |
|
Drugs used to promote attention |
Stimulants (amphetamines, methylphenidate), nonstimulants (atomextine, buproprion, clonidine) |
|
Desirable effects for anesthetic |
induction of anterograde amnesia, skeletal muscle relaxation, inhibition of undesired autonomic reflexes, analgesia |
|
Thiopental |
Enhance GABAa, barbituate, IV general anesthetic |
|
Propofol |
Enhance GABAa, IV general anesthetic |
|
Etomidate |
Enhance GABAa, IV general anesthetic |
|
Benzodiazepines |
Enhance GABAa, IV adjuvant anesthetic drug to initially depress level of consciousness to produce amnesia or reduce anxiety |
|
Fentanyl |
mu opioid receptor agonist. IV Adjuvant anesthetic used for analgesia. Effects reversible by naloxone. |
|
Ketamine |
NMDA antagonist. IV Dissociative anesthetic - dissociates patient from environment. |
|
Desflurane |
Likely act at GABAa. Inhaled general anesthetic |
|
Nitrous oxide |
weak NMDA antagonist. Weak depressor of consiousness. Inhaled anesthetic. |
|
Succinylcholine |
Depolarizing neuromuscular blocking agent. |
|
Vecuronium |
Competitive inhibition of ACh receptors, neuromuscular blocking agent. |
|
Typical pattern of brain hemispheric specialization |
Left dominant for propositional language. Right dominant for nonverbal, spatial abilities. 30% chance of being reversed in left-handed or ambidextrous. |
|
Left hemispheric control |
propositional language, analyzing complex stimuli (details), analyzing temporal sequence |
|
Right hemispheric control |
Processing non-verbal/visuospatial information, synethesizing diverse parts into a whole (big picture), processing spatial information |
|
Brocas area |
inferior frontal gyrus (Left), controls muscle of speech and PRODUCTION of all forms of language |
|
Wernickes area |
superior termoral gyrus (Left), COMPREHENSION of all forms of language |
|
Angular gyrus and supramarginal gyrus |
Involved with reading and writing |
|
Lesion in left hemisphere or thalamus |
Aphasia - acquired disorder of language. Anomia - inability to name a recognized object |
|
Lesion in angular gyrus or supramarginal gyrus |
alexia - acquired disorder of reading. Differs from dyslexia which is a congenital reading disorder. May also have agraphia - acquired disorder of writing. |
|
Lesion in Broca's area (inferior frontal gyrus) |
Aphasia. Patient has slow, effortful speech, that is telegraphic. All other forms of output (writing, signing, foreign languages) are also affected. Comprehension is preserved. |
|
Lesion in Wernickes area (superior temporal gyrus) |
Aphasia. Speed of speaking normal but often uses wrong words or word-like sounds (paraphasic error). Often incomprehensible. Patient's comprehension of auditory and visual language is impaired |
|
Lesion in the right hemisphere or parts of motor basal ganglia. Same disorder seen in Parkinson's disease. |
Aprosodia. Speech lacking emotion of affection, loss of melody. Sounds like a robot. |
|
Lesion in right cerebral hemisphere or right thalamus |
Hemi-inattention. Neglect of left space. No visual field defects, but ignores everything perceived to be in their left field. May also have constructional apraxia - inability to put parts together into a whole |
|
A lesion in the right or left cerebral hemispheres or thalamuses can cause this inability to copy drawings despite having comprehension of the task. |
constructional apraxia |
|
Bilateral lesion of occipital temporal visual system (sparing visual area) |
Visual agnosia - inability to recognize objects despite normal visual acuity. Can recognize objects when presented auditory/tactile. Ex. patient can copy the image of a pig, will know its an animal, but cannot recognize the animal. If the patient hears "oink-oink" they know that's a pig. |
|
Lesion of medial prefrontal lobe |
difficulty initiating and sustaining motor acts. Appear apathetic / indifferent, decrease in spontaneity. |
|
Lesion in orbital prefrontal lobe |
socially disinhibited, ignore long-term needs, live in the present, unconcerned about pain/death |
|
Lesion in dorsal prefrontal lobe |
inability to deal in abstractions, difficulty changing strategies. Preservation - repetition of old behavior. Inability to plan for future. |
|
Medial temporal lobe structures (hippocampal formation) important for memory |
Parahippocampal gyrus, subiculum, hippocampus, dentate gyrus. All part of cerebral cortex. |
|
Lesion in any of medial temporal lobe structures (usually diffuse) |
basic amnesia syndrome - inability to learn new facts (short-term memory), retrograde amnesia, intact procedural memory, confabulation |
|
Medial diencephalic structures |
Mammillary nuclei, important for memory and dependent of vitamin B1 |
|
Lesion in left medial temporal lobe or left medial diencephalic structures |
inability to form memories of verbal facts and events. (right sided lesions = inability to remember non-verbal facts/events) |
|
Major cognitive disorder |
significant cognitive decline in one or more domains, substantial impairment on cognitive testing, interference with independence in daily activities, cannot not be due to delirium or other mental disorder like depression. |
|
Types of hallucinations |
release hallucinations (spontaneous neuronal firing), due to neurochemical effects (5-HT2A, Anticholinergic, excess DA), dreams, ictal, from migraines, psychotic (schizoprenia, PTSD) |
|
Delusions |
firmly held false belief despite evidence to the contrary. Always psychotic. Can result from lesion or neurological disorder. |
|
Psychosis |
Loss of ability to determine what is reality. Secondary to neurological lesions in cerebral hemispheres or thalamus |
|
Conversion symptoms |
relatively persistent loss in sensory or motor function that cannot be explained by a physical disorder. Caused by "self-hypnosis" |
|
Factitious disorder |
patient intentionally falsifies or produces physical/psychological sx, but does not know why they are doing it. Muchausen syndrome is an extreme form where patients constantly hospitalize themselves. |
|
Malingering |
conscious faking of neurological or other illness, typically done for a specific purpose. Legal rather than medical problem. |
|
Haloperidol |
D2 receptor antagonist. First gen Antipsychotic. Decreases DA activity in mesocortical/mesolimbic pathways in the VTA. |
|
Quetiapine and Aripiprazole |
D2 antagonist + 5-HT2A antagonist. 2nd gen antipsychotic. |
|
Donepezil |
cholinesterase inhibitor. Tx: cognitive impairment from Alzheimers, only modest effect since impairment not solely from decrease in ACh in basal forebrain. |
|
Memantine |
low affinity NMDA R antagonist. Tx: cognitive impairment from Alzheimers, modest effect. |