Chronic Neuro

  1. What's the difference between a Tension Headache and Migraine?
    Tension Headache - bilateral, mild-moderate

    Migraine - usually unilateral throbbing, moderate-severe, can last hours to days
  2. What are the two main treatments for migraines?
    • Abortive Therapy
    • Prophylaxis
  3. Abortive Therapy:
    What does it mean?
    What are the drugs?
    What are their methods of actions?
    Terminate the headache one it's started

    • Triptans: Sumitriptan (Imitrex)
    • Ergotamine: DHE

    • Vasoconstrictors
    • (Not for people with HTN)
  4. What kind of drugs are used in prophylaxis treatment?
    • Beta Blockers
    • Calcium Channel Blockers
    • Tricyclic Antidepressants
    • Anticonvulsants
  5. Cluster Headache
    What is it?
    How does it occur?
    How long does it last?
    Headaches that occur in clusters for weeks to months

    Vasodilation of trigeminal area

    Stabbing pain of orbital, supraorbital or temporal area

    60-90 minutes
  6. Cluster headache treatments:
    • High flow O2
    • Ergotamine
    • Calcium Channel Blocker - Verapamil
  7. Headaches can often be confused with what other diagnoses?
    • Temporal Arteritis
    • Trigeminal Neuralgia
    • Tumor
    • Aneurysm
    • Infection
    • Trauma
  8. What are the diagnostic tests for headache?
    • None if the diagnosis is not clear
    • CT or MRI for trauma
    • LP for infection
  9. What is an autoimmune degeneration of the CNS that happens via demyelination?
    Multiple Sclerosis
  10. What are some s/s for Multiple Sclerosis?
    • Urinary Retention
    • Weakness
    • Muscle spasms
    • Dysphagia
    • Dysphasia
    • Neuropathic pain
  11. Purpose for Multiple Sclerosis treatment:
    For acute exacerbations

    • (Taper dosage)
    • (Multiple side effects)
  12. Purpose for Multiple Sclerosis treatment:
    • Decreases exacerbation
    • Helps flu-like symptoms

  13. Purpose for Multiple Sclerosis treatment:
    Stimulate flaccid bladder
  14. Purpose for Multiple Sclerosis treatment:
    • Muscle spasms
    • Decrease seizure threshold
  15. What drugs treat bladder spasms for Multiple Sclerosis?
    • Oxybutynin (Ditropan)
    • Tolterodine (Detrol)
  16. The disease of the basal ganglia causes
    Parkinson's Disease
  17. What are some s/s of Parkinson's Disease?
    • Resting tremor
    • Bradykinesia
    • Rigidity
    • Loss of postural reflexes
    • Shuffling gait
    • Blank or "masked" expression
    • Dysphagia
  18. What is the #1 choice medication for Parkinson's Disease?
    Levodopa/Carbidopa (Sinemet)

    (If overmedicated, can lead to psychosis)
  19. How does Entacapone (Comtan) interact with Sinemet?
    Improves efficacy
  20. For a Parkinsonian, when is the best time to give protein?
    At night
  21. What is an autoimmune disease of the neuromuscular junction?
    Myasthenia Gravis
  22. What are the s/s of Myasthenia Gravis?
    • Fatigue
    • Weakness in eye movements, chewing, swallowing, speaking
    • Difficulty breathing
  23. What medications must be avoided with Myasthenia Gravis?
    • Quinide
    • Beta Blockers
    • Aminoglycosides
    • Procainamine
    • Phenytoin
    • Neuromuscular Blockers
  24. What diagnostic test improve Myasthenia Gravis?
    What drug must be on hand as the antidote?
    Tensilon Test

  25. Treatments for Myasthenia Gravis
    • Neostigmine (Prostigmine)
    • Corticosteroids
    • Immunosuppressants Azathioprine (Imuran)
    • Thymectomy
    • Plasmaphoresis
  26. What is the difference between Myasthenic Crisis and Cholinergic Crisis?

    How do you differentiate the two?
    • MC - Severe muscle weakness, impacts swallowing and breathing
    • CC - Similar presentation but caused by excessive cholinergic drugs

    Tensilon Test
  27. A 45y/o woman with Myasthenia Gravis presents to the ER with trouble swallowing and difficulty breathing. Which of the following are true:

    B) A Tensilon test will be need to establish the etiology of the crisis
  28. A 78y/o male is experiencing worsening of his Parkinson's Disease. He notes that he is "freezing" and has difficulty walking in the late afternoon. Which actions should the home health nurse take?

    • A) Review his medication dosage and scedhuling, an discuss with the
    • physician

    (His meds are wearing off)
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Chronic Neuro