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
What are the two main treatments for migraines?
Abortive Therapy
Prophylaxis
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)
What kind of drugs are used in prophylaxis treatment?
Beta Blockers
Calcium Channel Blockers
Tricyclic Antidepressants
Anticonvulsants
Cluster Headache
What is it?
How does it occur?
S/S?
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
Cluster headache treatments:
High flow O2
Ergotamine
Calcium Channel Blocker - Verapamil
Headaches can often be confused with what other diagnoses?
Temporal Arteritis
Trigeminal Neuralgia
Tumor
Aneurysm
Infection
Trauma
What are the diagnostic tests for headache?
None if the diagnosis is not clear
CT or MRI for trauma
LP for infection
What is an autoimmune degeneration of the CNS that happens via demyelination?
Multiple Sclerosis
What are some s/s for Multiple Sclerosis?
Urinary Retention
Weakness
Muscle spasms
Dysphagia
Dysphasia
Neuropathic pain
Purpose for Multiple Sclerosis treatment:
Corticosteroids
For acute exacerbations
(Taper dosage)
(Multiple side effects)
Purpose for Multiple Sclerosis treatment:
Beta-Interferon
Decreases exacerbation
Helps flu-like symptoms
(Self-injection)
Purpose for Multiple Sclerosis treatment:
Bethanechol
Stimulate flaccid bladder
Purpose for Multiple Sclerosis treatment:
Baclofen
Muscle spasms
Decrease seizure threshold
What drugs treat bladder spasms for Multiple Sclerosis?
Oxybutynin (Ditropan)
Tolterodine (Detrol)
The disease of the basal ganglia causes
Parkinson's Disease
What are some s/s of Parkinson's Disease?
Resting tremor
Bradykinesia
Rigidity
Loss of postural reflexes
Shuffling gait
Blank or "masked" expression
Dysphagia
What is the #1 choice medication for Parkinson's Disease?
Levodopa/Carbidopa (Sinemet)
(If overmedicated, can lead to psychosis)
How does Entacapone (Comtan) interact with Sinemet?
Improves efficacy
For a Parkinsonian, when is the best time to give protein?
At night
What is an autoimmune disease of the neuromuscular junction?
Myasthenia Gravis
What are the s/s of Myasthenia Gravis?
Fatigue
Weakness in eye movements, chewing, swallowing, speaking
Difficulty breathing
What medications must be avoided with Myasthenia Gravis?
Quinide
Beta Blockers
Aminoglycosides
Procainamine
Phenytoin
Neuromuscular Blockers
What diagnostic test improve Myasthenia Gravis?
What drug must be on hand as the antidote?
Tensilon Test
Atropine
Treatments for Myasthenia Gravis
Neostigmine (Prostigmine)
Corticosteroids
Immunosuppressants Azathioprine (Imuran)
Thymectomy
Plasmaphoresis
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
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
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
